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DUSTY  AIR  AND  ILL  HEALTH 


"Having  long  been  a  student,  I  thought  myself  qualified 
in  time  to  become  an  author    .... 

"At  last  I  began  to  write,  and  as  I  finished  any  section  of 
my  book,  read  it  to  such  of  my  friends  as  were  most  skilled  in 
the  matter  which  it  treated.  None  of  them  were  satisfied ; 
one  disliked  the  disposition  of  the  parts,  another  the  colours 
of  the  style;  one  advised  me  to  enlarge,  another  to  abridge. 

1  resolved  to take  my  own  way  and  write  on,  for 

by  consultation  I  only  perplexed  my  thoughts  and  retarded 
my  work    .... 

"At  last  there  came  a  grave  man,  who  desired  to  see  the 
work,  and  without  opening  it  told  me,  that  a  book  of  that  size 
'would  never  do.' " 

SAMUEL  JOHNSON. 


DUSTY    AIR 

AND 

ILL    HEALTH 


A  STUDY  OF 
PREVALENT  ILL  HEALTH  AND  CAUSES 


BY 

ROBERT  HESSLER,  A.  M.,  M.  D. 


PKINTED  PRIVATELY 
1912 


Copyright  1912 

by 
Robert  Hcssler 


B.   IURFOR0  PRIN1 
INDIANAPOLIS 


PREFACE 


111  health  is  a  topic  that  concerns  all  of  us.  If  we  do  not  have 
ill  health  ourselves  there  a,re  sure  to  be  relatives  or  friends  to  give 
us  concern.    In  order  to  suffer  one  need  not  be  sick. 

An  observant  patient  told  me  there  are  two  classes  of  people 
whom  one  can  always  interest.  First,  those  who  have  saved  a  little 
money  and  want  to  know  how  to  invest  it  safely  so  it  will  bring  in 
some  returns.  Second,  those  who  have  not  the  best  of  health  and 
Avant  to  know  how  to  better  it.  These  two  classes  will  exist  as  long 
as  human  society  lasts. 

It  is  generally  admitted  that  ill  health,  and  particularly  chronic 
ill  health,  is  one  of  the  great  causes  of  misery  and  of  poverty. 

We  should  try  to  discriminate  between  ill  health  and  disease. 
Few  men  living  under  unsanitary  surroundings,  as  found  in  cities 
and  towns,  or  who  occasionally  come  in  contact  with  them,  are 
wholly  free  from  symptoms  of  ill  health.  As  a  matter  of  fact,  ill 
health  (that  is  symptoms)  affects  many  of  us  constantly.  Well- 
defined  disease  on  the  other  hand  occurs  only  at  long  intervals, 
indeed  may  not  appear  until  near  the  close  of  life.  Moreover 
well-defined  specific  diseases  are  as  a  rule  readily  diagnosed  by 
the  skilled  physician,  while  in  the  case  of  many  common  ills  diag- 
noses vary  greatly.  An  old  chronic  is  apt  to  get  all  sorts  of  diag- 
noses, including  that  of  imaginary  ill. 

To  what  extent  shall  we  ignore  minor  ills  or  symptoms?  To 
what  extent  shall  we  heed  them  and  indeed  study  them  and  find 
out  the  reason  or  cause?  (If  the  "old  chronic"  relies  solely  on 
the  medical  profession  for  relief  he  is  apt  to  be  disappointed — he 
must  study  himself.) 

The  manuscript  of  this  volume  has  been  discussed  with  a  num- 
ber of  people,  especially  with  "dust  victims,"  with  people  who 
react  to  dusty  air,  and  with  people  who  have  had  much  experience 

(5) 


O  DUSTY    AIR    AND    ILL    HEALTH. 

with  ill  health.     .Many  topics  here  briefly  touched  upon  have  been 
discussed  at  length. 

This  is  not  a  "family  doctor  book,"  nor  is  it  a  "complete  guide 
to  health,"  because  certain  kinds  of  cases  only  are  considered  and 
a  certain  factor  is  emphasized.  Properly  considered  this  is  a  mon- 
ograph on  dust  influences. 

A  physician  meets  all  sorts  of  patients,  all  sorts  of  dust  victims. 
For  some  a  short  explanation  suffices,  others  require  details  and 
repetitions.  A  book  like  this  may  be  compared  to  a  newspaper: 
it  appeals  to  a  variety  of  readers.  Some  things  are  read  by  head- 
lines, entire  pages  may  be  skipped. 

This  volume  is  not  written  for  the  practitioner  of  medicine :  he 
wants  greater  details,  he  wants  detailed  case  reports  and  facts 
rather  than  explanations  and  discussions.  Nor  is  it  written  for 
those  who  want  positive  or  dogmatic  statements;  on  the  contrary 
the  aim  is  to  show  that  much  is  still  to  be  learned  and  that  the 
general  reader  can  assist  in  solving  some  of  the  problems  relating 
to  ill  health. 

The  primary  ideas  underlying  this  volume  are  based  on  observa- 
tions on  first  entering  medical  college  in  the  fall  of  1889.  The 
author's  first  "Dust  paper"  wras  written  in  1893.  Since  the  sum- 
mer of  1900  he  has  made  a  systematic  study  of  dust  influences  and 
has  presented  papers  before  medical  and  scientific  societies.  In  the 
preparation  of  this  volume  published  papers  have  been  freely 
drawn  upon.  The  case  reports  and  discussions  were  selected  from 
a  large  original  collection. 

It  is  said  that  facts  are  stupid  things  until  brought  into  connec- 
tion with  some  general  law.  Often  a  mass  of  facts  are  explained 
by  some  hypothesis.  A  theory  that  satisfactorily  explains  many 
facts  and  that  enables  us  to  predict  becomes  a  working  theory,  of 
value  in  our  daily  life. 

This  volume  may  be  considered  as  a  contribution  to  the  dis- 
cussion of  the  dust  evil  or  the  dust  problem,  especially  in  relation 
to  ill  health.     Dust  is  a  neglected  factor  in  ill  health. 

March,  1912. 


CONTENTS 


PREFACE. 

I.     Introductory   Chapter 11 

The  kind  of  people  the  physician  meets.  Chronics.  The  exceptional 
tenth  case.  Ill  health  as  a  biological  problem.  The  simple  vs.  the  complex. 
Farmers  and  the  simple  life.  Farmers  and  change  of  environment.  A 
simple  Case  Report.  New-fangled  diseases.  Family  physician  vs.  special- 
ist. Our  "Triad  of  National  Diseases" — catarrh,  dyspepsia,  and  nervous 
prostration.  "Dust  Victims."  "It's  malaria"  as  an  explanation  of  ill 
health.  "It's  what  I  eat"  as  an  explanation.  Open  air  vs.  indoor  air  life. 
Remarks  on  food  and  drink,  alcohol,  clothing.  "Overwork"  as  an  explana- 
tion. School  children.  Need  of  a  National  Department  of  Health.  Dis- 
eases and  their  causes.  Delicate  school  children  vs.  robust  teachers.  "It's 
the  noise"  as  an  explanation  of  ill  health.  Unhealthy  towns  and  homes. 
"The  New  Doctor  in  Town."  People  who  move.  Occupational  influences. 
Ancestry,  rural  and  urban.  Inheritance  vs.  environment.  Family  histories. 
Symptoms  as  warnings.  Adaptation  to  environment.  Some  simple  expla- 
nations of  ill  health.  "It's  the  stomach,"  "It's  dyspepsia,"  etc.  "Threat- 
ened with"  as  an  explanation.  Old  chronics  and  the  physician.  Newspaper 
medicine.  Fashionable  explanations :  neurasthenia,  uric  acid,  auto-intoxi- 
cation. "Interesting  cases."  Physician  and  returns  for  efforts.  Medicine 
a?  an  evolution.  Symptoms  as  reactions.  Pathology  of  the  living.  Breath- 
ing, drinking,  eating.     Perils. 


II.    Local  Conditions  and  Changes  in  Time 45 

(Mesology  and  Ecology.) 

Topography.  Climate.  Natives.  Early  Immigrants.  Early  Settlers. 
"Natives."  Foreigners.  Pests  and  Parasites.  Diseases  and  their  Causes. 
Occupation  vs.  Ill  Health  and  Disease.  Occupations  and  Meeting  Places. 
Tropical  Diseases.  Introduced  Weeds.  Disease  vs.  Ill  Health.  Classifi- 
cation of  Diseases.  Studying  Diseases  and  111  Health.  Evolution  of  the 
Physician  (table).  The  Indian  Medicine  Man.  Early  Army  Surgeons. 
Medical  Schools.  To  Doctor  and  Doctoring.  Medical  Inspection  and 
Health  Supervision. 

(7) 


8  DUSTY    AIR    AND    ILL    HEALTH. 

III.     Dust  and  Dust  Victims 62 

The  Evolution  of  Dust  (table).  Country  Road  Dust.  Dust  From 
Paved"  streets.  Class  Dust.  Pollen  Dust.  Spit  Dust.  Smoke  and  Smog. 
Indoor  Dust.  Dust  of  Dwellings.  Featherbed  Dust.  Sterilized  and  Un- 
sterilized  Dust.     "Beneficent  Dust." 

Spitting  or  Expectoration.  Spitting  Black.  "Do  Not  Spit."  Sidewalk 
Spitting.     Coniosis.     Crowd  Poison.     Dust  Poison. 

Dust  Victims.  Classification  of  Dust  Victims:  Simple  Type;  Rheu- 
matic Type;  Digestive  Tract  Type;  Nervous  Type;  Cardie- Vascular  Type, 
Classifying  Patients.  Classifying  the  People.  Patients  or  Fellow-students. 
Missionary   Spirit.     A  Personal   Mention. 

A  few  Case  Reports  or  Case  Histories  of  Simple  Dust  Victims.  Young 
Farmer.  Middle-aged  Housewife  in  City.  A  Young  Woman  in  City. 
The  Seasonal  Factor.     Darkest  Before  Dawn. 


IV.     Colds  and  Catarrh 103 

"Everybody  has  Catarrh."  "American  Catarrh."  Colds  and  Catarrh 
as  Synonyms.  "Triad  of  American  Diseases" — Catarrh,  Dyspepsia,  and 
Nervous  Prostration. 

Kinds  of  Colds.  Classifying  Colds:  Attic  Colds.  Automobile  Colds. 
Book  Dust  Colds.  Carpet  Colds.  Church  Colds.  Court  House  Colds. 
Dance  Hall  Colds.  House-cleaning  Colds.  Railway  Colds.  School  Colds. 
Vacuum  Cleaner  Colds.  X-Colds.  Under  What  Conditions  Does  One 
Catch  Colds?     Overheated  Rooms.     Varying  Manifestations  of  Colds. 

Family  Histories.     Three  Histories. 

Dust  Infection  and  Age.    Time  Lost  on  Account  of  111  Health. 

Climate.  Climatic.  Weather,  and  Dusty  Air  Influences.  Dust-free 
Air.     Change  in  Climate. 

Localized  Pain.  Backache.  Rheumatic  Cases.  A  Mention  of  Several 
Case  Reports. 

Health  in  the  Country  and  in  the  City.  A  Rheumatic  Case.  The  Air 
of  Places. 


V.     Dyspepsia 151 

Early  Misunderstood  Cases.  Cases  in  which  the  Dust  Factor  was 
Recognized.     Some  Simple  Cases. 

Constipation.  Auto-intoxication.  Biliousness.  Differential  Diagnosis. 
Ruling  Out.     Cancer  of  the  Stomach  and  Cases. 

Membranous  Catarrh  of  the  Intestines.  A  Series  of  Case  Reports. 
Discussion  of  Symptoms  of  111  Health  with  Patients.  List  of  Symptoms 
Case  Report  and  Medical  Ethics. 


CONTENTS.  9 

Weeding  Out  on  Account  of  111  Health  and  Disease.  Several  Case 
Reports. 

Weeding  Out  and  Schools.  Several  Case  Reports.  Who  makes  the 
best  family  physician? 

VI.  Nervous  Prostration 212 

Misunderstood  Patients.  "The  short  and  simple  annals  of  the  poor." 
Case  Reports.  Clerks  in  Stores.  Patent  Medicines.  Routine  Attention. 
High  or  Low  Blood  Pressure.  Unsanitary  Municipal  Conditions.  The 
Advertising  Doctor.     The  Nostrum   Evil.     Newspaper  Medicine. 

Case  Report.  Clergyman.  Patent  Medicines  and  Adverti'sements. 
Cure  vs.  Relief.  Newspapers  and  Patent  Medicine  Advertisements.  Clean- 
ing up  as  a  Remedy.    Women  and  the  Politicians. 

Case  Report.  Middle-aged  Housewife,  neither  sick  nor  well.  Bug- 
bears. Disease,  111  Health,  Symptoms.  Should  a  patient  be  told  the  truth? 
Experimenting  and  being  Experimented  upon.  Fears  and  Phobias.  Dust 
Fear. 

Hospital  Physicians  and  Physicians  in  Private  Practice.  Medical 
Supervision,  Health  Supervision.     "Old  Age  Deferred." 

VII.  Cardio- Vascular  Affections  or  Heart  and  Kidney 

Cases 258 

High  and  Low  Blood  Pressures.  Subjective  and  Objective  Symptoms. 
Best  of  Health  and  Life  Insurance.  Prediction,  the  Test  of  Science. 
Chronic  Diseases  and  Occupation.  High  Pressure  Life.  The  Strenuous 
Life. 

Cardio-Vascular  Case.  Middle-aged  Housewife.  Discussions  with 
Patients.  Living  in  Isolation.  To  what  extent  shall  one  advise  a  life  of 
seclusion?  Going  to  Church  or  Not.  "The  Door-keeper  in  the  House  of 
the  Lord."  Advising  a  Patient  to  Move.  Keeping  a  Daily  Record.  Mental 
Influences.  Neglecting  Symptoms.  Euthanasia.  Discussion  of  Symptoms. 
Symptoms  of  111  Health  vs.  Symptoms  of  Disease.  Symptoms  of  111  Health 
as  Warnings  from  Nature.  List  of  Symptoms.  Diseases  vs.  Affections,  vs. 
Symptoms. 

VIII.  Specific  Diseases 289 

Analogies  Between  Diseases  and  Plants.  Native  vs.  Introduced  Dis- 
eases. Milk-Sickness.  Malaria.  Yellow  Fever.  Cholera.  Leprosy. 
Smallpox.  Measles  Scarlet  Fever.  Influenza.  The  Plague.  Tubercu- 
losis.   Diphtheria.    Typhoid  Fever.     Pneumonia.     Syphilis  and  Gonorrhea. 

Weeds  and  Diseases.     Collecting  Specimens,  Collecting  Case  Reports. 


10  DUSTY    AIR   AND   ILL   HEALTH. 

IX.  Biography  and  III  Health 302 

Collecting  Letters  and  Autobiographies.  Autobiographic  Case  Report. 
Physical  vs.  Mental  Life.  Case  Reports  at  Second-hand.  Case  Reports 
from  Newspapers  or  Journals. 

Biography  and  the  Influence  of  Environment.  Indiana  Biographies: 
Governor  O.  P.  Morton.  New  England  Biographies:  Louisa  M.  Alcott. 
J.  G.  Whittler.  W.  H.  Prescott  English  Biographies:  Mrs.  E.  B.  Brown- 
ing. Thomas  Carlyle.  George  Eliot.  Charles  Darwin.  Three  Visiting 
Englishmen :     Charles  Dickens,  Thomas  H.  Huxley,  Herbert  Spencer. 

X.  Perils  and  a  Remedy 328 

APPENDIX. 

Photographs  of  Sidewalk  Conditions 338 

Index    341 


I. 

INTRODUCTORY. 


In  the  course  of  time  a  physician  meets  all  sorts  of  people  hav- 
ing all  sorts  of  ill  health  (not  to  speak  of  well-defined  diseases) 
Math  all  sorts  of  explanations,  both  for  their  own  ills  and  for  those 
of  others  and  of  whole  communities.  It  is  the  exceptional  indi- 
vidual who  does  not  have  some  sort  of  explanation.  Those  with 
much  ill  health  as  a  rule  give  attention  to  matters  with  which  the 
well  or  healthy  are  not  at  all  concerned. 

From  what  sources  do  the  people  learn  about  common  ills  and 
common  ill  health  and  causes?  Manifestly  from  observations,  from 
discussions,  from  readings,  and  from  consultations  and  perhaps 
from  discussions  with  physicians. 

The  interest  a  man  takes  in  a  subject  often  depends  on  how 
intimately  it  concerns  his  welfare;  he  may  neglect  mild  symptoms 
but  he  must  heed  severe  ones. 

Among  individuals  in  chronic  ill  health  are  those  who  neglect 
symptoms ;  they  are  few  in  contrast  to  the  many  who  are  inquisitive, 
some  so  much  so  that  they  become  an  annoyance  to  the  physician 
who  is  not  interested  in  ordinary  ill  health,  only  in  well-defined 
diseases.  As  a  rule  chronics  make  the  rounds  of  the  doctors  and 
perhaps  try  all  modes  of  treatment;  some  try  all  the  patent  medi- 
cines that  appear,  even  faith  or  mind  cures.  Some  believe  in  try- 
ing all  things  and  holding  on  to  that  which  is  good.  Some  will 
try  a  thing  only  if  it  appeals  to  their  reason.  I  know  old  chronics 
who  never  took  patent  medicines;  one  may  say  such  persons  are 
exceptional. 

Need  it  be  added  that  there  are  all  sorts  of  people  with  all  sorts 
of  wants  and  needs  and  that  there  are  all  sorts  of  "medicine  men" 
to  supply  wants?  Some  people  expect  medicine  only,  they  want 
no  explanations.  Some  want  large  doses,  other  small  doses.  Some 
want  a  maximum  of  explanation  with  a  minimum  of  medicine. 
Exceptionally  a  man  may  apply  for  advice  only,  not  for  medicine 

(id 


12  DUSTY    AIR    AND   ILL    HEALTH. 

— such  exceptional  cases  have  become  more  and  more  common  in 
the  last  few  years. 

Now  in  the  very  beginning  it  should  be  kept  in  mind  that  there 
are  exceptions  to  every  general  statement.  One  can  scarcely  make 
a  general  remark  without  adding  some  qualifying  words  or  clause, 
and  one  can  scarcely  make  any  remark  but  some  one  cites  an  ex- 
ceptional case.  Therefore  it  should  be  understood  that  in  this 
volume  I  have  in  mind  the  nine-tenths  that  come  within  the  scope 
of  general  remarks,  neglecting  the  tenth  as  perhaps  wholly  excep- 
tional. Out  of  ten  cases,  or  patients,  nine  may  have  traits,  com- 
plaints, wants  and  desires  in  common,  the  tenth  may  differ  radi- 
cally. Out  of  ten  people  who  complain  of  ill  health,  perhaps  only 
one  goes  to  a  scientific  physician.  Out  of  those  who  do  apply  to 
physicians,  likely  nine-tenths  complain  of  common  ills;  it  is  the 
tenth,  the  exceptional  case,  that  may  have  a  specific  disease  de- 
manding specific  or  special  treatment.  Of  ten  physicians,  nine  will 
likely  have  certain  traits  or  characteristics  in  common,  people  know 
what  to  expect ;  the  tenth  may  be  exceptional,  he  may  be  an  unusu- 
ally skilled  physician,  or,  on  the  other  hand,  he  may  be  a  charlatan 
of  the  worst  kind. 

Somewhat  similar  remarks  may  be  made  regarding  our  news- 
papers: they  get  all  sorts  of  criticism.  And  yet,  after  all,  nine 
may  be  little  criticised ;  it  is  the  tenth  that  comes  in  for  any  amount 
of  denunciation  on  one  side  or  praise  on  the  other.  Again,  we 
constantly  speak  about  the  weather,  but  no  one  speaks  of  the  ordi- 
nary or  average  weather ;  we  only  talk  about  the  extremes  of  heat 
or  cold,  of  dry  or  wet;  ordinary  weather  is  scarcely  considered, 
and  yet  extreme  variations  are  exceptional. 

In  this  work  my  intention  is  to  speak  of  people  in  ill  health; 
moreover  of  the  "general  run  of  cases,"  not  of  the  exceptional 
case.  The  kinds  of  cases  to  be  dealt  with  are  what  may  be  called 
"old  chronics,"  people  who  have  been  complaining  for  some  time, 
who  have  perhaps  made  the  rounds  of  the  doctors,  in  short  have 
tried  all  sorts  of  remedies  and  modes  of  treatment.  In  other  words, 
I  am  writing  about  people  who  complain  of  ill  health  for  people 
who  have  more  or  less  ill  health.     Perhaps  nine-tenths  may  be 


INTRODUCTORY.  13 

benefited  by  my  advice ;  the  tenth,  the  exceptional  case,  may  neither 
be  interested  nor  does  my  advice  apply. 

In  order  that  a  physician  may  give  good  advice  he  must  study 
his  patient,  his  family  history,  and  the  surroundings  under  which 
he  lives.  Good  advice  implies  investigation.  If  both  patient  and 
physician  work  together  they  may  arrive  at  some  definite  conclu- 
sions. If  the  doctor  assumes  that  he  knows  it  all  and  his  patients 
know  nothing  there  is  not  apt  to  be  a  lasting  relationship  of  pa- 
tient and  physician.  If  a  man  doubts  the  abilities  and  knowledge 
of  a  physician  no  relationship  may  be  established.  On  the  other 
hand,  if  a  man  is  too  ignorant  to  make  long  explanations  worth 
while,  the  physician  may  not  accept  him  at  all  or  else  dismiss  him 
at  the  first  opportunity.  "With  ignorance  even  the  gods  strive  in 
vain.     There  may  be  exceptions  to  all  these  statements. 

The  problem  of  ill  health  is  really  a  biological  problem,  to  be 
solved  like  any  other  problem,  by  patient  study  and  observation! 

Discussion  is  necessary  to  arrive  at  the  truth,  but  discussions 
should  be  of  essentials.  The  physician  may  assume  certain  things 
to  be  of  prime  importance,  but  his  patient  may  be  inclined  to  dwell 
on  unessential  details.  "Old  experienced  patients"  soon  learn  to 
make  distinctions. 

From  my  notes  and  "case  reports"  for  the  last  twelve  years, 
I  have  laid  aside  a  number  for  remarks  on  topics  connected  with 
the  subject  of  ill  health,  and  particularly  chronic  ill  health,  as 
opposed  on  the  one  hand  to  health  and  on  the  other  to  well-defined 
or  specific  diseases.  With  some  patients  I  had  many  and  long 
discussions;  we  tried  to  learn.  I  shall  briefly  refer  to  a  few  cases 
and  supposed  causes.  Needless  to  say  in  cases  where  notes  extend 
over  a  long  series  of  years  only  brief  abstracts  can  be  given ;  to  do 
some  cases  justice  would  require  a  volume  for  each. 


In  studying  anything  it  is  best  to  begin  with  the  simple  and 
gradually  trace  it  into  the  complex.  The  farmer  leads  a  compara- 
tively simple  life  and  lives  under  a  simple  environment  and  causes 
of  ill  health  may  perhaps  be  more  readily  traced.  But  the  term 
farmer  is  rather  vague,  there  are  all  sorts  of  farmers.     Similar 


14  DUSTY   AIR   AND   ILL   HEALTH. 

remarks  apply  to  the  term  country  or  city  or  "out  West."  What 
do  we  mean  by  these  terms?  There  are  all  sorts  of  farmers,  good, 
bad  and  indifferent.  What  do  we  understand  by  a  "typical 
farmer?"  Manifestly  the  one  who  regularly  attends  farmer's  in- 
stitutes, who  takes  prizes  at  farm  and  poultry  shows,  is  a  different 
individual  from  the  mossback,  hayseed  or  rube  who  comes  to  town 
at  short  intervals  to  loaf  on  street  corners  and  spit  tobacco  juice. 
Only  too  often  the  latter  is  merely  a  tenant  on  a  rundown  farm, 
with  no  inducement  to  look  ahead  and  build  up  the  soil. 

I  shall  have  frequent  occasion  to  refer  to  farmers  and  unless 
the  contrary  is  mentioned  it  should  be  understood  that  I  am  refer- 
ring to  those  of  the  better  class.  Needless  to  say  I  have  had  some 
of  the  worst  type  as  patients,  often  for  only  a  short  time  because 
there  was  little  in  common  between  us.  Next  to  being  a  physician 
I  should  like  to  be  a  farmer;  although  I  have  never  lived  on  a 
farm,  I  believe  I  should  enjoy  it. 

A  farmer  of  eighty  years,  one  of  the  original  "old  settlers," 
from  an  adjoining  county,  came  to  me  complaining  of  an  irritation 
of  the  respiratory  mucous  membranes  marked  by  more  or  less  pro- 
fuse secretions.  He  had  always  lived  in  the  country,  remote  from 
town  life,  until  a  year  ago  when  he  rented  out  his  large  farm  and 
removed  to  a  small  village.  He  now  spent  much  time  at  the  village 
store  on  the  proverbial  cracker  barrel.  Soon  he  began  to  complain. 
He  consulted  first  one,  then  the  other  of  the  two  village  or  country 
doctors,  but  since  neither  helped  him  he  came  to  the  conclusion  he 
had  some  "new-fangled  disease  which  the  country  doctors  did  not 
understand. ? '  He  concluded  to  consult  a  town  doctor.  On  coming 
to  me  he  said,  ' '  The  country  doctor  is  good  enough  for  the  common 
ills  and  ailments,  but  it  takes  somebody  who  has  studied  more  and 
has  had  more  experience  to  treat  these  new-fangled  diseases  that 
are  constantly  coming  in."  The  man  had  had  little  schooling  and 
had  little  book  learning,  but  he  was  a  shrewd  observer.  He  thought 
he  had  some  new  or  unusual  disease,  possibly  due  to  "change  in 
the  climate."  It  turned  out,  however,  that  his  affliction  was  due 
to  change  of  environment,  of  exchanging  the  air  of  an  isolated 


INTRODUCTORY.  15 

country  home  for  that  of  a  village,  and  particularly  of  the  village 
store  where  spitters  congregate  about  the  stove,  especially  on  winter 
days,  and  contaminate  the  air.  Instead  of  having  a  rare  disease, 
he  had  become  afflicted  with  a  very  ordinary  malady,  nothing  more 
than  common  catarrh. 

Now  a  physician  can  make  an  offhand  diagnosis,  merely  saying, 
You  have  catarrh,  and  give  a  prescription  or  dispense  a  medicine, 
or  give  more  or  less  general  advice  regarding  treatment,  perhaps 
with  some  advice  regarding  prevention,  but  unless  the  patient 
clearly  understands  the  relationship  of  cause  and  effect  he  may  be 
wholly  unable  to  guard  himself.  Quite  probably  in  time  he  tries 
other  physicians  and  also  "catarrh  cures"  advertised  in  the  news- 
papers or  recommended  by  druggists.  Some  people  will  save  and 
starve  in  order  to  buy  medicines  "guaranteed  to  cure,"  nostrums 
which  a  physician  knows  can  not  cure ;  they  meet  others  who  have 
been  doing  the  same  thing,  who  have  made  the  rounds,  and  in  time 
they  come  to  believe  that  catarrh  is  incurable,  and,  since  it  is  so 
prevalent,  they  are  inclined  to  believe  that  "everybody  has  ca- 
tarrh. ' ' 

To  what  extent  do  physicians  explain  the  why  and  the  wherefore 
and  the  nature  of  catarrh  and  how  it  passes  or  travels  from  one  to 
another  (by  means  of  dried  catarrhal  spittle  inhaled  as  dust) ,  and 
that  it  should  be  looked  upon  as  a  preventable  reaction  rather  than 
as  an  incurable  disease? 

My  patient  spoke  of  "new-fangled  disease,"  meaning  some 
newly  arrived  or  recently  discovered  disease.  To  some  extent  a 
similar  explanation  dwells  in  the  minds  of  some  physicians — in- 
stead of  looking  for  common  causes  and  for  common  affections 
they  are  always  looking  for  uncommon  ones  and  for  rare  diseases, 
reasoning  that  others  overlooked  them  or  else  did  not  recognize 
them. 

The  farmer  also  spoke  of  "changes  in  climate."  "It's  the 
climate"  is  a  common  explanation  of  ill  health  (not  to  speak  of 
disease)  that  can  not  otherwise  be  accounted  for.  But  people  for- 
get that  we  really  have  two  climates,  a  natural  one  out  of  doors, 
an  artificial  one  indoors.     Many  house-plants  do  not  nourish  in- 


16  DUSTY    AIR    AND    TLL    HEALTH. 

doors,  they  merely  winter  over;  on  being  put  out  in  the  spring 
they  thrive.  Many  people  are  in  the  same  position.  Moreover  the 
natural  climate  may  itself  be  modified,  as  in  the  large  city  with 
an  absence  of  trees  and  grass,  with  dense  smog  clouds  obscuring 
the  sun. 

This  old  farmer  was  shrewd.  When  I  pointed  out  what  had 
occurred,  he  promptly  changed  his  mode  of  life,  particularly  by 
avoiding  "bad  air,"  and  the  reaction  ceased,  in  other  words,  his 
"disease"  disappeared. 

We  had  many  discussions  regarding  early  Indiana  conditions, 
he  was  one  of  the  pioneers.  I  have  made  these  discussions  the 
basis  for  a  short  chapter  on  Changes  in  our  State,  changes  that 
are  more  or  less  common  to  other  States.  The  subject  of  climate 
will  also  be  briefly  considered  later. 

The  farmer's  ideas  that  "city  doctors  know  more"  referred  to 
a  very  debatable  topic.  A  doctor  may  cover  the  whole  field  of 
medicine,  treat  everybody  that  applies,  or  he  may  devote  himself 
to  a  very  small  field  and  know  that  field  thoroughly.  No  man  can 
know  it  all ;  he  may  have  a  general  knowledge,  more  or  less  diffuse, 
or  special  knowledge  applicable  to  comparatively  few  cases.  From 
whom  will  the  mass  of  people,  the  nine-tenths,  complaining  of 
common  ills  get  the  best  service? 

Specialists  of  necessity  are  found  only  in  cities  where  they  find 
enough  cases  to  keep  them  busy  and  where  people  go  to  find  them. 
A  country  specialist  "can  not  be  a  good  one,"  people  reason,  or 
he  would  go  to  the  large  city.  In  general  this  is  true,  but  there 
are  exceptions. 

In  the  city  the  "family  physician"  has  largely  disappeared, 
each  member  of  a  family  may  have  a  different  physician  or  con- 
sult different  ones  on  different  occasions  or  for  different  ailments. 
In  the  country  the  family  doctor  still  flourishes.  In  the  case  of 
common  ills  he  is  the  bast  man  to  consult.  But  naturally  enough 
if  a  man  finds  his  complaints  persisting  and  if  he  gets  no  satisfac- 
tory explanation  why  he  is  still  uncured  and  is  perhaps  incurable 
(although  his  complaints  may  be  wholly  preventable),  he  may 
feel  like  consulting  the  city  doctor  who  is  supposed  to  know  more 


INTRODUCTORY.  17 

— just  as  some  people  go  to  the  great  German  specialists  who  are 
also  supposed  to  know  more.  In  the  case  of  our  common  ills,  espe- 
cially our  "Triad  of  National  Diseases"  (catarrh,  dyspepsia,  and 
nervous  prostration)  we  may  question  whether  foreigners  know 
more  than  our  own  physicians.  The  best  physician,  like  the  best 
naturalist,  is  the  one  who  knows  his  own  parish  best. 

Another  farmer,  a  middle-aged  man  of  unusual  intelligence, 
came  to  me  saying  he  was  told  I  had  the  reputation  of  trying  to 
find  out  the  causes  of  ill  health  and  disease.1  He  said  he  felt  bad 
every  time  he  came  to  town  or  went  into  a  crowd,  he  would  feel 
achy  throughout  the  body,  with  more  or  less  mental  dulness  or 
headache,  and  an  irritation  of  the  throat,  at  times  he  would  have 
a  decided  cold.  He  had  had  various  explanations  from  physicians 
but  none  enabled  him  to  prevent  attacks.  Could  I  explain  the 
nature  of  the  attacks  and  give  some  advice  on  how  to  prevent  them  ? 

I  promptly  recognized  him  as  a  "Dust  Victim"  and  told  him 
I  knew  a  lot  about  such  eases,  for  I  myself  reacted  when  air  con- 
ditions were  very  bad.  He  listened  closely  to  what  I  told  him 
about  my  own  experiences  and  to  my  explanations;  said  he  had 
long  suspected  dust  as  the  cause  of  his  attacks,  but  he  now  saw 
that  he  did  not  distinguish  between  kinds.  I  explained  what  "in- 
fected dust"  meant.    Kinds  of  Dust  will  be  considered  later. 

I  assumed  he  would  return  "for  further  instruction"  and  that 
I  would  get  more  data,  but  he  did  not  return.  The  simple  expla- 
nation was  all  he  needed ;  I  learned  this  a  few  years  later  through 
a  common  friend. 

Another  patient,  a  farmer's  wife  living  near  the  first  men- 
tioned farmer,  came  to  me  with  symptoms  of  ill  health  which  were 
supposed  to  be  due  to  malaria.  She  had  been  dosed  with  quinine, 
at  times  to  such  an  extent  that  she  became  weak  and  anemic  and 
had  to  "rest  up" — in  order  to  take  more  quinine.  She  had  been 
given  various  explanations  for  her  continued  ill  health,  "malaria" 

1  As  a  matter  of  fact  I  had  the  reputation  of  being  a  pathologist;  physicians  often  sent  me  obscure  cases  to 
be  worked  out. 

Since  this  volume  is  based  mainly  on  personal  experiences  and  observations  and  a  first-hand  study  of  people 
in  ill  health,  there  of  necessity  is  frequent  occurrence  of  the  pronoun  I. 

12 


18  DUSTY   AIR    AND   ILL   HEALTH. 

was  most  frequent.  She  had  also  been  told  "It's  grip."  I  was 
able  to  point  out  to  her  that  something  else  was  at  the  bottom  of 
her  symptoms  and  that  what  she  needed  was  not  quinine  but  out- 
of-door  air.  When  she  lived  up  to  my  advice  she  soon  found  that 
it  was  not  malaria. 

The  belief  that  malaria  is  the  cause  of  much  of  the  common  ill 
health  is  an  old  one;  if  it  is  not  malaria  outright  then  it  is  "ma- 
larial," "concealed  malaria,"  "a  touch  of  malaria,"  if  not  "mias- 
matic." Real  malaria  (malarial  fever)  was  formerly  very  common 
in  Indiana  and  any  case  of  illness  was  at  once  supposed  to  be  ma- 
laria or  due  to  malarial  or  miasmatic  influences.  The  belief  in 
malaria  as  a  cause  of  common  ill  health  has  largely  disappeared 
among  medical  men,  but  lives  on  among  the  people,  fostered  by 
some  patent  medicine  men.  With  no  instructions  how  are  the  peo- 
ple to  know  better?  The  belief  will  no  doubt  gradually  die  out 
with  the  disappearance  of  people  who  lived  when  malaria  was 
widely  prevalent.  The  term  malaria  literally  means  bad  air;  it 
goes  back  to  ancient  days. 

There  is  an  old  time  belief  that  night  air  is  injurious.  This 
belief  goes  back  to  the  early  days  when  people  who  went  indoors 
at  sundown  were  less  likely  to  be  affected  by  malaria,  because  the 
mosquito  that  transmits  malaria  flies  and  bites  by  night.  Log 
houses  filled  with  more  or  less  smoke  from  the  open  fireplace  or 
merely  the  odor  of  smoke,  were  not  visited  by  mosquitoes.  There 
is  still  another  factor,  the  smoking  of  tobacco.  To  smoke  means 
to  drive  away  mosquitoes.  What  is  more  natural  than  that  people 
living  under  simple  life  conditions  should  smoke  in  the  evening, 
not  only  the  men  but  also  the  women  ?  The  plea  that  tobacco  keeps 
away  disease  and  ill  health  might  at  one  time  have  been  made  with 
good  reason,  but  it  no  longer  holds.  Malaria  today  is  a  rare  dis- 
ease. (I  live  in  a  locality  once  highly  malarial,  but  the  disease  is 
now  rare;  I  have  not  seen  a  single  case  for  nine  years.) 

When  we  read  biographies  of  men  who  have  had  much  ill  health, 
we  find  that  at  various  times  different  explanations  have  been  used 
to  a  large  extent.  William  Cullen  Bryant  mentions  how  the  doc- 
tors of  his  time  explained  all  ill-defined  eases  by  "It's  malaria." 


INTRODUCTORY.  19 

"It's  malaria"  was  a  common  explanation  in  our  State.  It  is 
still  used  to  some  extent  but  is  falling1  into  disuse,  because  real 
malaria  has  almost  disappeared.  People  are  beginning  to  under- 
stand that  a  certain  kind  of  mosquito  transmits  the  disease  and 
that  before  the  mosquito  can  transmit  it  it  must  have  bitten  some- 
body who  has  real  malaria.  Hence  a  suspected  case  of  malaria 
without  any  other  cases  of  malaria  about,  or  occurring  in  mid- 
winter when  there  are  no  mosquitoes,  leads  to  suspicion  regarding 
the  correctness  of  the  diagnosis.  Moreover  the  careful  physician 
nowadays  examines  the  blood  of  his  patient  and  is  able  to  make  a 
definite  diagnosis,  whether  malaria  is  present  or  not,  he  no  longer 
guesses  or  even  ventures  a  guess  at  the  diagnosis,  and  he  no  longer 
overdrugs  his  patient  with  quinine. 

"It's  grip"  is  still  a  common  explanation  especially  when  many 
are  attacked,  as  after  a  midwinter  thaw.  Since  the  appearance  of 
influenza  in  the  winter  of  1889-90,  "It's  the  grip"  has  been  fre- 
quently heard.  Grip  is  one  of  the  synonyms  for  influenza.  It  has 
largely  taken  the  place  of  "  It 's  malaria. "  As  a  matter  of  fact,  real 
grip  is  an  epidemic  disease  that  comes  at  intervals  of  years  and  at- 
tacks practically  everybody,  killing  many.  What  is  now  commonly 
called  ' '  grip ' '  may  be  said  to  be  merely  a  severe  form  of  ' '  common 
cold."  Is  the  term  "grip"  more  terrifying  than  "cold?"  Are 
the  doctor's  patients  more  likely  to  follow  his  advice  if  told  they 
have  the  grip? 

"It's  what  I  eat"  is  a  frequent  explanation.  People  accuse 
this  and  that  article  of  food  and  avoid  it.  A  physician  occasion- 
ally meets  people  who  live  on  toast  and  weak  tea.  Food  may  of 
course  be  a  cause  or  factor  of  ill  health  and  continued  ill  health 
but  more  often  it  is  less  a  question  of  what  is  eaten  than  of  con- 
ditions under  which  food  is  eaten.  Take,  for  instance,  pie ;  whether 
one  eats  it  at  home  fresh  from  the  oven  or  at  a  restaurant  where 
it  has  been  exposed  to  the  air  and  flies  and  dust  for  hours  may 
make  a  marked  difference  in  after-effects.  Similarly  with  foods 
that  have  been  exposed  before  stores  to  the  dust  of  side-walks. 
Sanitarians  fully  recognize  the  importance  of  clean  food.  Today 
there  are  all  sorts  of  laws  and  ordinances,  the  latest  prohibiting 


20  DUSTY   AIR   AND   ILL   HEALTH. 

exposure  of  food  to  street  dust.  Such  restrictions  do  not  apply  to 
the  farmer  living  in  isolation ;  he  gets  clean  or  pure  food  at  first 
hand. 

For  countless  ages  man,  like  other  animals,  has  been  thriving 
on  natural  foods.  Some  animals  thrive  only  on  certain  foods ;  they 
become  extinct  with  a  disappearance  of  the  supply.  It  is  only 
comparatively  recent  that  the  process  of  adaptation  to  artificial 
foods  has  begun.  Manufacturers  make  all  sorts  of  foods  to  sell, 
some  is  so  injurious  that  it  must  be  prohibited.  Improper  food  is 
especially  severe  on  infants  and  those  whose  digestion  is  impaired. 
Of  the  average  person  of  our  country  it  may  be  said  that  he  sub- 
sists on  plain  substantial  and  nutritious  food  and  that  in  the  ab- 
sence of  other  injurious  factors  he  thrives  on  it.  The  underfed 
people  of  many  countries  readily  fall  a  prey  to  ravaging  diseases. 
With  us  starvation  is  practically  unknown  but  cases  do  occur  now 
and  then,  mainly  in  the  slums  of  large  cities.  The  isolated  trav- 
eller on  the  desert  dying  from  starvation  belongs  to  an  entirely 
different  category. 

Primitive  man  was  an  open  air  animal,  seeking  shelter  only 
at  night  and  during  cold  weather.  Under  a  nomadic  mode  of  life 
there  was  no  accumulation  of  filth.  Two  thousand  years  ago  the 
people  of  northern  Europe  were  still  open  air  people.  In  many 
countries  today  the  urban  population  exceeds  the  rural,  indeed, 
many  rural  people  are  massed  in  villages,  more  or  less  constantly 
in  contact  with  each  other,  giving  diseases  an  opportunity  to  go 
from  one  to  another,  just  as  in  large  cities.  People  who  may  be 
considered  truly  rural  are  becoming  rare.  The  modern  fiat  dweller 
is  an  extreme  development  of  the  indoor  life  habit,  but  such  a  mode 
of  life  is  very  destructive  to  the  race;  it  virtually  means  race 
suicide. 

Old  time  cities  were  very  unsanitary,  there  was  a  constant  weed- 
ing out  of  humanity,  especially  where  there  was  impure  water  and 
bad  food.  But  old  time  cities  were  not  overhung  with  smoke  and 
dust  clouds  like  our  modern  industrial  cities,  consequently  there 
was  no  weeding  out  on  account  of  such  air  conditions. 

In  a  general  way  it  may  be  said  that  a  given  number  of  hours 


INTRODUCTORY. 


21 


out  of  doors  offsets  life  under  indoor  air  conditions.  The  time 
necessary  may  vary  greatly  in  different  individuals.  Some  can 
maintain  health  with  a  minimum  of  outdoor  air;  others  are  so  sus- 
ceptible to  indoor  air  that  they  can  not  live  in  a  city  at  all. 

People  of  course  vary  in  their  tolerance  of  bad  food.  Among 
slum  children  who  live  out  of  garbage  pails  the  mortality  rate  is 
high,  but  a  certain  number  will  reach  maturity.  Some  foods  we 
know  are  very  indigestible  and  yet  some  persons  are  able  to  thrive 
on  them.  For  instance,  we  hear  it  said  that  men  can  thrive  on 
sauerkraut  and  limburger  cheese,  rye  bread  and  beer.  Usually  we 
say  they  have  • '  strong  stomachs. ' '  But  what  of  those  who  live  on 
fried  potatoes,  pancakes,  soda  biscuits  and  steak  fried  in  grease? 

When  our  State  was  first  settled  game  was  abundant.  The  only 
kitchen  utensil  some  of  the  early  settlers  had  was  a  skillet,  even 
today  the  prospector  going  into  the  wilderness  has  his  skillet.  It 
would  seem  that  people  who  live  under  good  air  conditions  can 
thrive  on  foods  fried  in  grease  to  an  extent  that  people  massed  in 
unsanitary  cities  can  not.  Food  fads  of  all  kinds  thrive  in  unsan- 
itary cities.  City  physicians  generally  advise  against  the  use  of 
fried  food.  It  is  perhaps  needless  to  add  that  people  who  thrive 
on  fried  food  are  not  apt  to  consult  a  physician  at  all. 

The  early  settlers  took  advantage  of  the  native  food  supplies, 
game  of  all  kind  and  wild  fruits.  They  had  a  good  supply  of  the 
latter  and  some  were  looked  upon  as  delicacies.  My  old  patient, 
mentioned  a  few  pages  back,  spoke  of  papaws,  how  they  were  eaten 
freely,  and  yet  some  people  today  think  them  rank  poison.  In  dis- 
cussing the  question  we  came  to  the  conclusion  that  people  leading 
the  simple  open  air  life  can  tolerate  many  things  that  city  stomachs 
can  not.  But  perhaps  the  greatest  factor  in  giving  the  papaw  an 
evil  reputation  is  the  fact  that  city  people  get  them  after  the  fruit 
has  passed  through  many  hands  and  is  black,  soft,  partly  decayed, 
in  fact  must  be  regarded  as  a  culture  medium  for  all  sorts  of  micro- 
organisms. No  wonder  their  use  produces  bad  effects.  I  have  met 
people  who  could  not  eat  a  papaw  in  the  city  but  could  eat  them 
without  evil  effects  direct  from  the  tree.  One  may  say  similar 
arguments  apply  in  the  case  of  milk.     There  are  undoubtedly  in- 


22  DUSTY    AIR   AND    ILL   HEALTH. 

dividuals  with  whom  milk  disagrees  but  they  are  rare,  provided 
they  use  milk  direct  from  a  healthy  cow.  Milk  bought  at  the  corner 
grocery  may  be  loaded  with  micro-organisms  of  all  kinds;  no 
wonder  it  is  injurious. 

A  young  farmer  came  to  me  complaining  greatly,  expressing 
his  belief  that  "It's  what  I  eat."  Later  on  I  shall  tell  how  we 
found  out  differently. 

Drinking  water  is  often  accused  of  being  the  cause  of  more  or 
less  continued  ill  health.  Water  supplies  vary  greatly.  A  spring 
on  an  isolated  farm  may  supply  pure  or  clean  water  while  one  in 
or  near  a  town  may  be  highly  contaminated.  Similarly  with  wells ; 
well  water  may  be  clear  and  sparkling  yet  highly  polluted.  Dis- 
ease germs  are  very  minute  and  water  may  be  full  of  tliem  with- 
out showing  any  turbidity.  It  is  the  invisible  dangers  we  have  to 
guard  against.  In  cities  that  have  muddy  water  in  the  mains, 
people  often  or  usually  resort  to  clear  well  water.  City  people 
with  water  at  times  of  doubtful  purity  are  of  course  familiar  with 
the  cry  of  "Boil  the  water,"  especially  when  an  epidemic  threatens, 
particularly  typhoid  fever.  The  prevalence  of  typhoid  fever  in  a 
city  is  regarded  as  a  general  index  of  its  salubrity.  Well-managed 
cities  have  practically  no  typhoid  fever.  But  there  may  be  much 
ill  health  erroneously  ascribed  to  water.  Bad  water  is  undoubtedly 
an  important  source  of  disease,  as  typhoid  fever  and  diarrheal 
affections,  but  to  what  extent  general  ill  health  is  dependent  upon 
it  is  a  problem,  often  it  is  difficult  to  rule  out  complicating  factors. 

In  a  general  way  it  may  be  said  that  people  who  pay  no  atten- 
tion to  the  purity  of  their  drinking  water  are  equally  careless  in 
other  respects.  Often  the  physician  finds  it  difficult  to  discover 
the  actual  cause  of  ill  health,  he  may  not  even  attempt  to  rule  out 
one  thing  after  another.  A  man  who  lives  under  unsanitary  sur- 
roundings, or  comes  in  contact  with  the  sick  and  diseased,  who 
drinks  bad  water  and  eats  food  of  doubtful  purity,  and  breathes 
contaminated  air,  such  a  man  is  a  problem  to  a  physician.  On  the 
other  hand  the  student  of  ill  health  may  more  or  less  readily  trace 
causes  among  people  living  in  isolation,  as  the  farmers  just  men- 


INTRODUCTORY.  23 

tioned  as  well  as  city  people  who  are  cleanly,  who  use  clean  water 
and  clean  food  and  who  will  give  attention  to  the  matter  of  good 
or  bad  air.  The  moment  a  city  gets  a  clean  water  supply  the  gen- 
eral standard  of  cleanliness  is  raised  and  ill  health  and  disease  are 
reduced. 

''Abe  Martin"  speaks  of  "pump  towns,"  meaning  that  a  town 
either  has  no  municipal  supply  or  that  the  supply  is  of  such  a 
character  that  pumps  are  still  in  use,  hydrant  water  may  be  too 
dirty  even  to  bathe  in.  Some  people  when  they  come  to  a  doctor 
expect  a  lot  of  sympathy  besides  a  valuable  prescription,  but  like 
the  Pharisee  of  old,  instead  of  high  sounding  phrases  they  may  be 
told  to  wash  and  be  clean.  Clean  water  and  clean  streets  go  to- 
gether. Some  cities,  Berlin  for  instance,  scrub  their  streets.  In 
some  small  cities  for  a  woman  even  to  sweep  the  sidewalk  in  front 
of  her  house  is  regarded  as  an  oddity. 

One  of  my  early  patients  ascribed  all  her  ills  to  the  matter  of 
clothing.  She  was  either  dressed  too  little  or  too  much.  She  could 
not  tell  when  to  wear  wool  or  cotton.  Every  little  cold  she  caught 
was  ascribed  either  to  getting  chilled  or  getting  overheated.  I  was 
able  finally  to  make  it  clear  to  her  that  the  matter  of  clothing  was 
a  secondary  one,  that  under  good  air  conditions  all  that  was  neces- 
sary was  to  be  comfortably  dressed. 

Many  of  us  can  remember  how  red  flannel  around  the  throat 
was  supposed  to  be  both  curative  and  preventive  of  colds  and  sore 
throat.  Indeed  red  flannel  was  reputed  to  ward  off  illness,  espe- 
cially that  due  to  cold,  and  underclothing  was  made  of  it.  Today 
red  flannel  has  practically  disappeared  but  we  still  hear  and  read 
regarding  the  value  of  different  fibers,  especially  cotton  and  wool. 
The  question  is  sometimes  asked,  What  is  the  "healthiest  color" 
to  wear?  "White,  I  promptly  reply.  "But  white  shows  dirt." 
Exactly,  that  means  to  keep  clean.  Men  are  constantly  making 
fun  of  women's  dresses1  but  from  a  sanitary  standpoint  they  are 


1  From  the  standpoint  of  the  physician  the  present  style  of  short  and  narrow  skirts  is  a  great 
improvement  over  the  former  full  and  trailing  skirt  that  collected  any  amount  of  filth.  Incidentally, 
the  nostrum  maker  who  advertises  obesity  cures  has  reaped  a  harvest  from  fleshy  women  who  only 
too  often  suffer  in  health  in  attempting  to  reduce  their  weight.  Although  fashions  go  to  extremes, 
there  is  no  need  for  an  individual  to  resort  to  extreme  measures  in  order  to  be  fashionable. 


24  DUSTY    AIR    AND    ILL    HEALTH. 

ahead  because  their  dresses  are  frequently  laundered  while  men's 
clothing  (we  need  only  think  of  the  old  greasy  tramp)  is  worn 
week  after  week  and  month  after  month,  and  if  there  is  anything 
that  accumulates  microbes  it  certainly  is  an  old  suit. 

The  Chinese  wear  clothing  that,  can  be  washed ;  they  are  more 
cleanly  than  we  in  the  matter  of  dress.  The  Japanese  in  their  last 
war  with  Russia  appreciated  the  importance  of  clean  clothing  free 
from  infection.  They  put  on  clean  (that  means  sterilized)  cloth- 
ing before  going  into  battle  and  as  a  consequence  they  had  a  very 
low  death  rate  on  account  of  injuries.  Clean  clothing  meant  no 
infection  was  carried  into  the  wounds.  I  recall  a  statement  re- 
garding the  Communists  of  Paris,  how  even  slight  injuries  proved 
fatal,  the  reason  assigned  being  the  use  of  alcohol. 

Now  alcohol  for  a  long  time  has  been  accused  of  doing  all  sorts 
of  things.  It  makes  the  sick  well  and  the  well  sick.  It  cheers  and 
it  dulls  sensibilities.  According  to  some  (not  only  doctors  but  also 
scientists  who  are  supposed  to  have  made  careful  studies,  perhaps 
experiments)  alcohol  is  a  food,  according  to  others  it  is  a  poison. 
Formerly  physicians  used  it  freely,  now  some  never  prescribe  it. 
The  people  themselves  are  divided  into  two  camps,  those  who  use 
it  and  those  opposed  to  its  use.  In  our  State  the  alcohol  question 
is  a  great  political  issue. 

Since  the  Commune  of  1871  a  new  science  has  arisen,  bacteri- 
ology. At  that  time  practically  nothing  was  known  regarding 
microbes  and  the  role  they  play  in  infection,  not  only  of  wound 
infection  but  general  infection.  In  the  light  of  bacteriology  phy- 
sicians now  readily  understand  how  soldiers  in  the  city  were  sur- 
rounded with  infection  on  all  sides  and  how  injuries  through  dirty 
clothing  brought  on  infection,  why  even  slight  wounds  were  fatal, 
and  why  on  the  other  hand,  the  Japanese  in  the  Russo-Japanese 
war  so  largely  escaped  infection  by  acting  upon  the  principles  of 
bacteriology  and  wearing  sterilized  clothing.  The  latter  moreover 
lived  in  the  open  air. 

In  our  Civil  War,  General  Sherman  noticed  that  his  soldiers 
while  on  the  march  or  in  camps  away  from  towns  escaped  much 
sickness  and  even  common  colds.    The  mortality  from  wounds  and 


INTRODUCTORY.  25 

from  sickness  was  much  greater  in  city  hospitals  than  in  field 
camps.  The  surgeon  today  is  fully  alive  to  the  question  of  clean- 
liness. 

In  a  general  way  it  may  be  said  that  pathogenic  or  disease- 
producing  microbes  occur  only  where  men  are  massed  together. 
Practically  speaking  they  do  not  occur  in  the  isolated  country.  A 
hunter  and  trapper  in  the  wilderness,  for  instance,  can  injure  him- 
self in  all  sorts  of  ways  and  recover  promptly,  while  a  mere  pin 
scratch  under  dirty  city  conditions  may  lead  to  ' '  blood  poisoning, ' ' 
to  infection.  Not  only  are  our  clothing  and  skin  full  of  infection 
but  also  our  food  and  water  and  air;  common  pus  germs  (staphyl- 
ococci and  streptococci)  are  abundant  where  people  are  massed. 
The  city  resident  must  be  cautious.  People  living  in  isolation  es- 
cape many  dangers  due  to  infection  from  others. 

A  long  chapter  might  be  written  on  the  influence  or  relation- 
ship of  clothing  to  health  and  ill  health,  but  there  is  one  point  that 
is  generally  overlooked,  the  relationship  of  clothing  to  the  purity 
of  the  air.  People  living  under  bad  air  conditions  find  it  difficult 
to  regulate  the  amount  of  clothing,  while  people  living  under  good 
air  conditions  scarcely  notice  even  marked  changes  in  temperature. 
The  same  is  true  regarding  the  heating  of  houses.  Under  good  air 
conditions  a  lower  temperature  suffices  to  feel  comfortable,  while 
under  bad  air  conditions  we  want  houses  and  halls  and  railway 
coaches  overheated.  The  reason  Europeans  complain  of  our  houses 
being  overheated  is  perhaps  not  far  to  seek.  When  we  consider 
that  the  spitting  habit  (and  that  means  air  pollution)  prevails  in 
our  country  as  nowhere  in  Europe  the  explanation  is  plain. 

A  very  common  explanation  of  ill  health  in  school  children  is 
"overwork. ' '  The  fact  that  school  houses  are  poorly  ventilated  and 
that  the  air  is  bad  is  very  seldom  considered  at  all.  As  a  matter 
of  fact  there  is  "overwork,"  but  it  is  an  overworking  of  the  de- 
fences of  the  body  in  keeping  off  infection.  But  that  is  not  the 
kind  of  overwork  that  parents  and  teachers  have  in  mind. 

In  the  local  high  school,  for  instance,  the  question  of  overwork 
is  intimately  connected  with  the  question  of  proper  clothing,  as 


26  DUSTY    AIR    AND    ILL    HEALTH. 

these  in  turn  are  connected  with  the  matter  of  ventilation,  and 
that,  means  more  particularly  supplying  the  students  with  dust- 
free  air  of  proper  temperature.  Here  I  can  not.  go  into  details. 
I  will  merely  state  that  the  laboratory  class  room  is  in  the  cold  and 
dark  basement  and  children  need  to  be  warmly  dressed.  The  next 
hour  they  are  in  the  Assembly  room  on  the  top  floor,  with  a  trop- 
ical, an  overheated,  atmosphere,  and  then  they  complain  of  the 
heat.  How  are  the  children  to  know  what  is  a  proper  amount  of 
clothing!  The  basement  teacher  tells  them  to  dress  warmer,  while 
the  teacher  in  the  upstairs  rooms  may  tell  them  they  are  too  warmly 
dressed. 

In  this  connection  T  am  reminded  of  the  remarks  of  a  plumber 
who  was  consulted  about  the  heating  defects  of  a  large  two-story 
school  building  in  an  adjoining  town.  A  few  of  the  rooms  received 
most  of  the  heat  of  the  boiler  and  usually  were  overheated;  other 
rooms  were  too  cold.  He  found  that  the  school  authorities  at- 
tempted to  produce  an  "equable  temperature"  in  a  ridiculous  way, 
using  thermometers  that  did  not  read  true.  They  attempted  to 
mislead  those  who  judged  a  comfortable  temperature  by  some  in- 
strument. Rooms  that  had  too  much  heat  were  supplied  with  ther- 
mometers that  read  too  low,  and  cold  rooms  with  some  that  read  too 
high,  the  extreme  variations  between  thermometers  being  eleven 
degrees.  In  these  days  of  instruments  of  all  kinds  there  is  a  tend- 
ency to  overlook  the  feelings  and  sensibilities.  It  should  be  re- 
membered that  the  teacher  is  constantly  moving  about  while  the 
pupil  sits  still. 

It  was  just  mentioned  that  microbes  and  disease  germs  occur 
in  proportion  as  people  are  massed  together.  The  explanation  for 
that  is  simple :  There  are  all  sorts  of  pathogenic  or  disease  germs 
growing  in  all  sorts  of  animals  (not  to  speak  of  plants,  for  they 
also  have  diseases).  Some  grow  in  one  animal,  some  in  another; 
for  instance,  there  is  chicken  cholera  and  hog  cholera  and  human 
cholera  Disease  prevails  in  proportion  as  there  is  a  massing  to- 
gether under  unsanitary  conditions.  Farmers  have  learned  that 
hogs  do  not  thrive  under  unsanitary  conditions,  no  more  than 
human  beings.    The  Agricultural  Department  is  constantly  telling 


INTRODUCTORY.  27 

the  farmer  how  to  protect  his  chickens  and  hogs  and  plants  but  it 
has  nothing  to  say  how  to  protect  himself  or  his  children.  We  need 
a  National  Department  of  Health. 

Many  germs  grow  in  or  upon  the  human  body  and  the  body  in 
attempting  to  get  rid  of  them  reacts  and  the  reaction  is  known  as 
disease.  Diseases  may  be  recognized  either  by  their  active  causes 
or  the  grouping  of  their  symptoms.  Microbes  or  parasites  may  be 
very  minute  or  they  may  be  large.  The  active  causes  of  influenza, 
or  diphtheria,  or  of  consumption,  for  instance,  are  very  minute. 
On  the  other  hand  there  are  parasites  living  in  the  intestinal  tract 
that  may  be  many  feet  in  length,  tape  worms.  In  the  South  the 
hookworm  is  a  very  important  cause  of  ill  health  and  disease.  It 
is  just  visible  to  the  unaided  eye. 

Microbes  and  parasites  from  the  sick  get  into  and  on  to  the 
bodies  of  the  well  by  various  ways,  by  direct  contact,  or  through 
clothing,  or  through  food,  through  water  or  air.  Itch  or  ringworm, 
etc.,  travel  from  one  to  another,  many  through  direct  contact. 
Typhoid  fever  and  cholera  are  transmitted  from  one  to  the  other 
mainly  through  drinking  water.  Consumption,  bronchitis,  catarrh 
and  colds  travel  mainly  through  the  agency  of  dust  particles  in 
the  air,  that  is,  the  secretions  and  excretions  on  the  floor  or  ground 
are  dried  and  pulverized  and  float  in  the  air  as  dust  and  when 
inhaled  reproduce  the  affection  or  disease. 

Some  individuals  are  very  susceptible  to  infection,  others  quite 
resistent.  It  is  the  old  story  of  seed  falling  on  good  or  on  stony 
ground.  (But  in  general  it  may  be  said  that  if  conditions  are 
favorable  no  one  escapes  infection.)  Weeds  do  not  appear  in  a 
field  unless  the  seed  is  brought  in  and  the  seed  must  be  in  a  con- 
dition to  germinate  and  find  conditions  for  germination  favorable. 
So  with  disease  germs.  If  the  seed  is  too  old  or  perhaps  has  been 
sterilized  by  bright  sunlight,  it  is  no  longer  able  to  germinate,  and 
hence  "dust  full  of  germs"  may  or  may  not  produce  disease  and 
ill  health.  Dust  exposed  to  bright  sunlight  for  even  an  hour  or 
two  is  sterilized.  Such  an  exposure  is  equivalent  to  cooking  the 
seed,  in  fact,  "boil  the  water"  means  to  kill  typhoid  and  other 
germs.    On  the  other  hand,  the  seed,  i.  e.,  disease  germs,  preserved 


28  DUSTY    AIR    AND   ILL   HEALTH. 

indoors  may  retain  vitality  for  a  long:  time.  The  farmer  knows  the 
importance  of  exposing  vessels  for  milk  to  the  bright  sunlight  and 
of  freely  ventilating  the  cellar  where  fruit  is  kept,  keeping  the  air 
sweet,  not  mouldy.  The  spittle  in  dust  of  public  halls  may  retain 
its  virulency  for  months. 

As  a  rule  school  children  do  not  spit  on  the  floor  but  they  bring 
in  filth  and  germs  from  the  sidewalks  and  they  distribute  infec- 
tious matter  from  running  noses,  as  when  they  shake  out  the  hand- 
kerchief previous  to  use.  Unless  there  is  free  ventilation  constantly 
carrying  off  the  infection  children  may  suffer  severely.  When 
infection  enters  the  body  there  is  a  reaction,  the  body  tries  to  get 
rid  of  it,  to  destroy  it.  In  reality  it  is  a  battle  between  host  and 
invader,  just  like  the  battle  between  those  in  the  fort  and  the  en- 
emy, one  or  the  other  will  prevail.  In  a  general  way  it  may  be 
said  that  if  the  body  is  placed  under  good  conditions  it  will  throw 
off  infection.  Sickness  that  keeps  a  child  at  home  from  school 
may  really  be  a  conservative  process;  it  enables  the  body  to  get 
rid  of  infection,  assuming  that  the  air  of  the  home  is  better  than 
that  of  the  school  room. 

This  struggle  is  an  important  one  and  determines  whether  a 
child  will  live  or  not,  and  yet  it  is  generally  misunderstood.  As 
already  mentioned,  when  a  child  is  not  feeling  well  physically  or 
mentally,  it  is  only  too  often  ascribed  to  ' '  overwork, "  that  is  the 
child  is  "studying  too  hard,"  while  as  a  matter  of  fact  the  over- 
work is  on  the  part  of  the  body  in  trying  to  get  rid  of  infection. 
Perhaps  the  value  of  open  air  schools  can  be  understood  in  the 
light  of  these  remarks.  Children  under  good  air  conditions  do  not 
readily  break  down;  they  can  do  a  large  amount  of  studying.  I 
frequently  see  high  school  students  on  the  point  of  "breaking 
down"  under  bad  air  conditions  and  barely  able  to  pull  through, 
but  they  may  be  able  to  do  an  immense  amount  of  work  while 
going  to  college  or  a  university  where  attention  is  given  to  air  con- 
ditions. If  such  a  student  after  graduating  from  the  high  school 
becomes  a  teacher  in  a  small  country  school  where  air  conditions 
are  good,  there  probably  is  good  health ;  if  he  teaches  in  an  unsani- 
tary school,  in  town  or  city,  he  may  and  usually  does  break  down. 


INTRODUCTORY.  29 

Today  there  is  a  demand  for  "robust"  school  teachers,  those 
who  are  sickly  or  complain  are  not  wanted.  Now  in  times  past  the 
farmer  boy  or  girl  whom  the  parents  thought  "delicate"  would  be 
sent  to  school  and  given  an  education  that  would  qualify  him  to 
teach.  The  same  of  course  is  true  of  many  a  city  child;  parents 
have  an  idea  that  delicate  children  should  have  an  indoor  occupa- 
tion. But  teachers  drawn  from  such  a  class  of  "delicate  people" 
are  apt  to  react  under  bad  air  conditions  found  in  schools  with 
poor  ventilation  and  not  kept  clean.  On  account  of  this  there 
were  so  many  teachers  who  were  always  complaining  that  now 
there  is  a  demand  for  robust,  non-complaining  ones.  Instead  of 
cleaning  up  and  ventilating  freely  and  making  air  conditions  suit- 
able for  people  who  are  apt  to  complain  on  account  of  bad  air,  we 
adopt  an  opposite  course,  we  rule  out  those  who  react,  those  who 
complain.  The  teacher  who  in  reality  is  a  living  barometer  is  not 
wanted. 

But  the  robust  teacher  like  the  robust  doctor  wholly  misunder- 
stands the  problem  of  ventilation,  of  good  air,  in  school  rooms. 
To  be  sure  the  sickly  teacher  may  also  fail  to  understand  the  why 
and  the  wherefore.  Some  come  from  homes  where  the  old  idea  of 
the  injuriousness  of  draughts  and  open  windows  still  prevails.  In- 
stead of  admitting  fresh  air  they  close  up  everything,  thereby  ag- 
gravating their  ills.  What  the  teacher  needs  is  education!  Is  it 
necessary  to  add  that  the  intelligent  teacher  who  has  always  com- 
plained about  ill  health  readily  adopts  good  air  advice?  Shall  we 
go  a  step  further  and  say  that  many  physicians  come  from  homes 
where  similar  ideas  regarding  draughts  and  open  windows  prevail 
and  that  if  they  are  taught  nothing  about  the  importance  of  good 
air,  neither  in  school  nor  in  medical  college,  they  may  wholly  fail 
to  understand  the  present  pure  air  movement  ? 

The  common  ill  health  and  common  ailments  of  school  children 
will  be  taken  up  separately. 

This  is  not  the  place  to  discuss  bacteriology,  that  is  a  vast  sub- 
ject. It  has  become  so  important  that  colleges  teach  it  and  indeed 
some  high  schools  even  have  elementary  courses  to  instill  definite 
ideas.    The  causes  of  many  diseases  can  be  cultivated  in  glass  tubes 


30  DUSTY   AIR    AND   ILL   HEALTH. 

on  proper  "culture  media,"  just  as  large  species  of  plants  can  be 
grown  in  the  garden.  Readers  interested  in  the  subject  can  likely 
obtain  a  volume  or  the  information  through  their  public  library. 
It  is  not  my  intention  to  consider  a  large  number  of  causes  of 
ill  health,  but  I  should  like  to  refer  briefly  to  a  few  in  addition  to 
those  already  mentioned. 

"It's  the  noise,"  I  have  had  several  patients  tell  me.  They 
had  an  idea  that  the  noises  of  the  city  made  them  ill.  One  farmer 
told  me  he  had  noticed  that  every  time  he  comes  to  town  he  gets 
ill,  he  feels  bad  even  if  he  goes  to  a  country  church,  or  wherever 
people  are  massed  together  and  there  is  a  buzzing  of  voices.  Farm- 
ers on  moving  to  town  may  have  continued  ill  health,  ascribing  it 
to  noises;  similarly  people  who  remove  from  the  suburbs  to  the 
heart  of  the  city.  When  one  critically  studies  such  individuals 
one  finds  that  it  is  not  so  much  what  goes  into  the  ear  as  what 
goes  into  the  nose  and  mouth  that  makes  them  ill. 

Noise,  smoke,  and  dust  are  of  course  intimately  bound  up.  The 
noisy  city  is  also  apt  to  be  a  smoky  and  dusty  one.  In  the  large 
city  a  physician  may  have  difficulty  in  separating  noise  and  dust 
and  other  influences.  The  isolated  country  doctor  finds  it  less  diffi- 
cult to  discriminate,  in  fact  he  may  have  unusual  opportunities. 

When  a  country  doctor  meets  a  case  of  smallpox  or  scarlet  fever 
or  measles  he  most  likely  at  once  inquires,  Where  did  you  get  it? 
The  patient  living  on  the  isolated  farm  must  of  course  have 
"caught"  the  disease  somewhere.  Exceptionally  it  may  have  been 
brought  in  by  a  letter  or  on  clothing  or  things  that  come  from 
town  or  from  neighbors,  but  more  commonly  the  individual  came 
in  contact  with  some  on  who  had  the  same  disease.  We  all  know 
how  some  diseases  are  regarded  as  very  "catching"  and  how  ef- 
forts are  made  to  isolate  those  who  are  sick  and  how  houses  are 
placarded.  Now  while  the  country  doctor  may  have  little  difficulty 
in  tracing  the  exposure,  the  city  doctor  may  utterly  fail,  because 
his  patients  are  constantly  coming  in  contact  with  countless  others. 

The  country"  man  who  goes  to  the  city  not  only  encounters  noises 
but  also  other  factors  that  produce  ill  health,  notably  bad  air.    He 


INTRODUCTORY.  31 

may  refuse  to  drink  water  and  escape  water-borne  diseases ;  he  may 
refuse  to  eat  in  the  city  and  thus  avoid  food-borne  diseases,  but  he 
can  not  avoid  breathing. 

The  matter  of  influence  of  noise  vs.  bad  air  is  an  interesting 
one  and  even  people  who  have  no  medical  education  can  make 
observations  that  are  of  value.  As  a  matter  of  fact,  many  obser- 
vations regarding  dust  influences  are  of  a  nature  that  do  not  re- 
quire a  medical  education,  just  plain  common  sense.  In  making 
such  a  statement  one  feels  impelled  at  the  same  time  to  criticise 
our  schools  for  their  failure  to  teach  children  to  observe  things; 
there  is  too  much  memorizing  from  books. 

"It's  unhealthy  towns  and  homes  that  make  one  sick,"  some 
say.  There  is  of  course  much  truth  in  such  or  similar  statements 
but  one  must  inquire  why,  in  what  way  do  home  and  town  condi- 
tions differ?  Why  are  some  towns  unhealthy  or  unsanitary  and 
others  not?  Do  the  people  get  the  essentials  of  a  healthy  life: 
proper  housing,  proper  rest  and  recreation,  pure  water,  pure  food 
pure  air?  These  are  questions  one  must  ask.  To  what  extent  is 
there  overcrowding  and  a  mere  struggle  for  existence? 

Many  towns  and  most  cities  for  a  long  time  have  given  atten- 
tion to  the  securing  of  good  water  and  they  have  laws  and  ordi- 
nances regarding  food,  but  so  far  practically  no  attention  has  been 
paid  to  the  matter  of  pure  air,  and  this  is  one  of  the  great  causes 
of  common  ill  health,  how  great  we  are  only  beginning  to  find  out. 

How  do  we  get  our  ideas  regarding  comparative  salubrity  or 
healthfulness  of  cities  and  towns?  Primarily  through  mortality 
statistics.  We  are  told  how  many  people  died,  what  percentage  of 
the  population,  and  of  what  diseases.  But  such  ideas  may  be  very 
erroneous  because  mortality  statistics  concern  themselves  only  with 
deaths,  with  people  who  died;  they  take  no  account  of  people  in 
ill  health.  A  man  may  have  years  of  ill  health  before  he  dies;  we 
hear  only  of  the  cause  of  his  death  and  his  age.  A  strong  country 
boy  goes  to  the  city,  he  soon  becomes  ill  and  returns  to  his  country 
home,  to  die;  his  death  is  accredited  to  the  country  and  not  to  the 
city  where  it  rightfully  belongs.     We  constantly  find  people  once 


32  DUSTY    AIR    AND   ILL    HEALTH. 

strong  drifting  back  to  the  country,  to  the  scenes  of  their  child- 
hood. Probably  the  best  method  of  judging  the  comparative  salu- 
brity (or  morbidity  as  opposed  to  mortality)  of  communities  is  by 
the  ratio  of  physicians  and  druggists  and  the  number  and  size  of 
patent  medicine  advertisements,  not  forgetting  a  city's  water  sup- 
ply and  the  condition  of  its  streets.  Good  water  and  clean  streets 
mean  healthy  people. 

A  young  physician  is  apt  to  get  all  sorts  of  advice  from  his 
friends  where  to  locate.  He  may  be  told  to  locate  in  a  certain 
community,  because  there  are  few  physicians  and  there  is  little 
competition.  But  every  experienced  physician  knows  that  a  com- 
munity with  many  physicians  offers  better  opportunities  for  the 
young  man.  Many  doctors  means  much  "doctoring."  There  is 
much  sickness,  i.  e.,  ill  health  due  to  unsanitary  surroundings  and 
reactions  due  to  an  abnormal  environment  (really  incurable  but 
largely,  if  not  wholly,  preventable).  The  sick  are  constantly  drift- 
ing around  ready  to  try  "the  new  doctor  in  town."  An  unsani- 
tary city  contains  any  amount  of  ill  health  that  is  not  curable 
through  the  use  of  medicine  but  which  is  curable  or  certainly  re- 
duceable  to  a  minimum  by  attention  to  things  other  than  the  taking 
of  medicine.  One  of  the  widely  read  popular  medical  journals  has 
a  slogan,  Clean  Up,  Clean  Out,  and  Keep  Clean.  If  the  people 
only  knew  what  that  implies !  In  short,  cleanliness  is  next  to  god- 
liness. 

Much  illness  is  dependent  on  overcrowding.  Leaving  the 
crowded  city  may  mean  a  return  of  health.  City  life  may  mean 
bad  water  and  bad  food  and  especially  bad  air.  When  a  man  goes 
to  the  country  and  eats  "good  country  grub"  he  likely  also  gets 
good  water  and  good  air,  and  that  may  mean  a  return  of  health. 
If  there  has  been  no  serious  injury  to  the  body  on  account  of  in- 
flammations and  scars  there  may  be  a  relatively  complete  restora- 
tion of  health;  but  we  all  know  that  many  wait  too  long  before 
making  a  change,  a  change  may  no  longer  bring  the  expected 
improvement.  Poor  people  are  often  unable  to  make  a  change; 
they  will  continue  to  work  as  long  as  possible,  until  they  break 
down.    Formerly  when  land  was  plentiful  a  man  could  go  out  and 


INTRODUCTORY.  33 

take  up  a  quarter  section  but  those  days  are  past.  Many  towns 
have  unhealthy  trades  and  occupations  and  as  long  as  men  follow 
them  they  will  have  ill  health. 

The  fact  that  much  of  the  common  ill  health  and  failure  of 
people  in  the  city  is  due  to  congested  population,  with  all  that  this 
implies,  is  evidenced  by  the  formation  of  societies  that  colonize 
people  in  the  country,  virtually  giving  a  man  a  new  chance  to 
maintain  an  independent  existence.  Cities  of  today  have  greatly 
improved  over  those  of  a  hundred  years  ago  but  much  is  still  to 
be  desired. 

The  physician  meets  people  often  who  are  constantly  moving 
about.  They  move  from  one  house  to  another,  from  one  street  to 
another,  and  from  one  town  to  another  and  perhaps  from  one  State 
to  another.  In  studying  a  number  of  these  individuals  I  found 
that  moving  was  often  really  a  search  for  better  health.  To  a 
number  of  these  individuals  I  have  been  able  to  point  out  that  the 
chief  factor  in  their  ill  health  was  bad  air  conditions. 

Occasionally  one  meets  people  wTho  say,  "It  is  my  occupation 
that  is  killing  me."  They  are  confident  that  if  they  had  a  differ- 
ent occupation,  especially  an  outdoor  one,  they  would  have  better 
health.  Often  they  speak  positively  because  they  have  tried  it. 
Many  have  made  changes  and  then  again  gone  back  to  the  old 
occupation.  The  physician  may  be  able  to  point  out  to  them  the 
reason  why,  that  many  occupations  are  carried  on  in  an  "indoor 
climate,"  under  artificial  air  conditions.  We  are  just  beginning 
to  realize  that  it  pays  to  have  good  air  in  factories. 

I  have  case  histories  of  men  who  moved  about  and  tried  all 
sorts  of  occupations  after  leaving  school.  They  tried  this  and  they 
tried  that;  at  times  they  felt  better  and  then  again  worse.  Yet 
it  is  the  exceptional  individual  who  has  any  idea  that  air  condi- 
tions are  at  the  bottom  of  it.  Many  a  country  boy  on  beginning 
city  life  has  among  his  duties  the  sweeping  of  a  store  or  office. 
Having  always  been  accustomed  to  good  air,  he  may  promptly 
react  to  bad  air,  air  full  of  infection.  He  may  try  all  sorts  of 
occupations  and  finally  drift  back  to  the  farm  without  ever  fully 
realizing  why  he  could  not  live  with  comfort  in  the  city.    In  many 

[3] 


34  DUSTY    AIR    AND   ILL    HEALTH. 

factories  there  is  dust  that  is  very  injurious.  It  is  the  exceptional 
individual  who  can  tolerate  it.  Many  occupational  diseases  so- 
called  are  due  to  dust  conditions.  This  is  a  suhject  to  which  sani- 
tarians are  giving  a  good  deal  of  attention. 

When  we  study  a  large  number  of  people  we  are  apt  to  find 
that  they  fall  into  two  groups,  those  whose  ancestors  have  always 
lived  under  rural  conditions,  country  people  as  we  say,  and  those 
whose  ancestors  have  perhaps  for  generations  been  living  under 
city  conditions.  Now  old  time  city  conditions  were  very  bad  and 
there  was  a  very  active  weeding  out  of  those  who  were  not  adapted. 
This  is  markedly  shown  by  the  Jews.  In  old  European  cities  they 
were  confined  to  ghettoes  with  gates  locked  at  night,  the  overcrowd- 
ing was  fearful;  many  perished  under  such  conditions.  The  de- 
scendants of  those  who  survived  are  able  to  thrive  under  present 
city  conditions.  On  the  other  hand  there  are  Jews  who  have  been 
living  under  rural  conditions,  especially  Russian  Jews,  who  are 
now  crowding  into  our  cities;  many  of  these  fail  quickly.  The 
weeding  out  now  goes  on  among  these  as  it  did  among  the  an- 
cestors of  the  others. 

We  see  this  weeding  out  process  again  among  the  descendants 
of  the  southern  mountaineers.  When  people  for  several  genera- 
tions have  been  living  under  very  primitive  conditions  practically 
all  have  a  chance  to  grow  to  maturity  and  reproduce  their  kind. 
When  these  mountaineers  or  their  descendants  crowd  into  cities 
many  promptly  fail,  the  "weak"  are  constantly  killed  off. 

A  middle-aged  woman  from  an  adjoining  town  came  to  me 
several  years  ago  with  a  history  of  chronic  ill  health.  She  had  the 
peculiar  faded  appearance  which  at  once  led  me  to  suspect  she  was 
of  southern  mountaineer  stock,  and  so  I  promptly  asked  regarding 
her  family  history.  My  suspicions  were  confirmed.  Her  ancestors 
were  mountaineer  people  who  came  to  this  State  when  she  was  a 
small  girl ;  they  settled  on  an  isolated  farm.  From  the  time  she 
became  of  school  age  and  went  to  school  she  complained  of  ill 
health.  After  school  days  there  was  better  health  and  then  she 
married  a  small  town  storekeeper.  Ill  health  now  reappeared, 
marked  by  colds  and  catarrh,  headache  and  dyspepsia,  and  a  "good 


ttrTfcobucToft?.  35 

for  nothing  feeling  generally."  She  had  an  idea  that  the  town 
was  unhealthy  and  induced  her  husband  to  sell  out  and  move  to 
another.  In  fact,  there  were  repeated  moves  and  her  husband 
became  a  "ne'er  do  well."  I  tried  to  explain  why  she  was  not 
adapted  to  town  life. 

When  the  woman  understood  she  spoke  of  her  only  child,  a 
daughter  now  almost  grown,  who  was  following  in  her  footsteps, 
had  similar  ill  health.  Her  ancestors  had  raised  large  families; 
she  had  only  the  one  child.  Perhaps  such  cases  explain  the  ex- 
tinction of  families. 

About  the  second  or  third  consultation  she  came  in  accompanied 
by  her  husband,  a  stout  full  blooded  man  who  did  not  give  her 
any  sympathy  and  believed  her  ills  were  imaginary.  Moreover  he 
was  quite  bitter  against  the  medical  profession  because  he  had 
spent  thousands  of  dollars  "all  for  nothing."  A  woman  with  such 
ill  health  and  under  such  circumstances  is  to  be  pitied. 

Another  common  explanation  is  that  of  inheritance.  People 
feeling  ill  may  say  they  know  they  have,  or  are  going  to  die  of,  a 
certain  disease,  because  some  other  member  of  the  family  has  or 
had  it.  On  the  other  hand  some  say  they  know  they  do  not  have 
such  and  such  a  disease  "because  nobody  in  the  family  ever  had 
it."  "When  people  feel  bad  or  have  chronic  ill  health  they  attempt 
to  account  for  it  by  the  presence  of  some  disease  or  being  perhaps 
in  an  "  early  stage. ' '  Many  physicians  do  the  same.  As  a  general 
rule  however  specific  diseases  are  of  comparative  short  duration. 
The  "terminal  disease,"  the  one  that  ends  life,  may  kill  quickly 
and  perhaps  have  no  relationship  whatever  to  the  preceding  years 
of  ill  health. 

One  of  the  great  questions  discussed  by  scientists  today  is  the 
relative  influence  of  heredity  and  environment.  The  subject  is 
complex.  Many  factors  must  be  considered.  To  the  physician 
the  question  is  important  from  the  fact  that  he  must  distinguish 
between  well  defined  diseases,  minor  maladies,  and  common  ill 
health.  In  the  case  of  many  diseases  there  is  developed  a  mutual 
adaptation,  but  many  individuals  not  feeling  well  are  not  diseased. 


36  DUSTY  AIR   AND   ILL  HEALTH. 

To  what  extent  is  their  ill  health  due  to  inheritance,  to  what  extent 
due  to  the  influence  of  environment? 

I  have  a  little  story  which  I  tell  those  who  are  so  positive  about 
the  matter  of  inheritance,  who  say  that  certain  disease  or  diseases 
are  present  or  absent  in  their  families,  in  substance:  An  Indian 
and  a  white  man  applied  for  life  insurance.  The  Indian  gave  a 
"good  family  history;"  there  was  no  consumption,  no  cancer,  no 
Bright 's  disease,  etc.,  in  his  family;  he  was  promptly  accepted. 
The  white  man  had  to  admit  that  in  the  past  some  members  of  his 
family  had  died  of  one  or  another  of  these  diseases,  in  other  words, 
his  "family  history  was  bad;"  he  was  rejected.  A  year  later  the 
Indian  was  dead;  he  and  his  ancestors  had  never  been  exposed  to 
the  "diseases  of  civilization,"  diseases  which  had  ravaged  among 
the  white  man's  ancestors  and  killed  off  the  susceptible.  The 
white  man,  in  spite  of  his  "bad  family  history,"  lived  on  and  on. 

Often  people  who  have  much  ill  health  express  the  belief  that 
they  will  not  live  long,  confusing  ill  health  with  disease  that  kills. 
To  such  I  quote  the  old  English  saying,  In  order  to  live  long,  ac- 
quire an  incurable  disease,  explaining  that  really  there  is  no  disease 
at  all,  only  ill  health,  and  that  the  symptoms  are  to  be  considered 
in  the  light  of  warnings  from  nature  not  to  go  to  extremes.  As  a 
rule  the  old  chronic  is  prudent:  his  pains  and  aches  tell  him  how 
far  he  can  go  and  when  to  desist,  and  because  he  is  careful  he  lives 
on  and  on. 

Years  ago  I  read  about  a  titled  Englishman,  the  last  of  his  line, 
all  his  ancestors  died  in  early  manhood.  If  there  was  anything  in 
heredity  he  knew  his  own  fate.  On  the  other  hand,  if  there  is 
anything  in  the  influence  of  environment  and  watching  oneself  he 
was  determined  to  prolong  his  life.  To  do  this  he  studied  medicine 
and  became  his  own  patient.  As  a  doctor  of  medicine  he  of  course 
felt  free  to  consult  his  fellow-physicians  and  get  their  best  advice. 
He  studied  his  own  case  and  watched  himself.  He  regarded  pains 
and  aches  as  warnings,  to  be  heeded  and  their  causes  to  be  avoided. 
He  died  of  old  age.  "Whether  the  story  was  true  of  course  I  do  not 
know,  but  it  is  a  good  story  to  tell  pessimistic  patients.  Care  and 
prudence  pay. 


INTRODUCTORY.  37 

On  considering  eases  one  has  actually  studied,  a  physician  might 
arrive  at  the  conclusion  that  for  the  average  individual  the  in- 
fluence of  environment  is  the  greater  factor.  This  is  fortunate 
because  we  can  largely  alter  our  environment,  make  an  unfavorable 
one  favorable,  or  remove  from  an  unfavorable  one,  while  we  have 
practically  no  control  over  the  influence  of  heredity.  It  should  be 
kept  in  mind  that  in  this  volume  we  are  considering  people  of 
European  descent.  If  the  Eskimo  and  the  South  Sea  Islander 
were  to  change  habitats  each  would  likely  promptly  perish,  but 
how  much  to  ascribe  to  environment  and  how  much  to  heredity  and 
the  weeding-out  factor  would  be  impossible  to  determine.  We  of 
the  temperate  zone  are  exposed  half  the  year  to  winter  and  half  to 
summer;  we  can  bear  exposures  that  those  of  the  arctic  and  torrid 
zones  can  not.  Need  it  be  added  that  well-to-do  people  who  are 
delicate  or  susceptible,  who  can  not  bear  the  heat  of  summer,  can 
go  north,  or  those  who  can  not  bear  the  rigors  of  our  winter  go 
south? 

People  whose  ancestors  have  lived  under  city  conditions  are 
likely  to  bear  unsanitary  conditions  to  which  the  descendants  of 
people  who  have  always  lived  in  the  country  would  promptly  suc- 
cumb. Some  people  are  able  to  live  in  the  worst  slums,  but  the 
"survival  of  the  fittest"  may  not  at  all  mean  the  survival  of  the 
best. 

People  have  all  sorts  of  explanations  regarding  their  ill  health 
and  its  causes.  Among  them  are  explanations  obtained  from  prac- 
titioners of  medicine.  But  often  such  explanations  are  very  simple : 
"It's  the  stomach,"  "It's  the  liver,"  "It's  dyspepsia,"  "It's  uric 
acid,"  etc.  People  of  course  want  an  explanation  when  they  are 
not  feeling  well  and  if  they  can  not  explain  to  their  own  satisfac- 
tion, then  some  one  must  explain  for  them — and  usually  the  busy 
doctor  gives  an  explanation  that  he  thinks  his  patient  can  under- 
stand. He  has  no  time  for  lengthy  discussions,  and  so  he  uses 
common  explanations,  such  as  the  above.  (For  a  longer  list  see 
the  advertisements  and  testimonials  of  patent  medicines  in  the 
newspapers.) 


38  DU8TY    AIR    AND   ILL   HEALTH. 

At  times  the  name  of  some  definite  disease  may  be  given.  An 
individual  may  be  told  he  has  tuberculosis,  or  "threatened  with 
consumption."  Exceptionally  an  individual  may  be  told  he  has 
cancer  (chronic  dyspeptics  often  have  a  fear  of  cancer  of  the 
stomach).  Another  may  be  told  he  has  Bright 's  disease.  As  a  rule 
however  practitioners  of  medicine  avoid  "diagnoses,"  that  is  ex- 
planations, of  this  kind  because  if  people  "get  scared"  they  may 
go  to  some  other  physician  or  to  a  specialist.  Merely  to  say,  "It's 
the  stomach,"  "It's  dyspepsia,"  is  rather  non-committal  and  is 
more  apt  to  lead  the  patient  to  believe  he  is  going  to  be  cured  than 
if  he  is  given  the  diagnosis  of  cancer,  or  consumption  or  Bright 's 
disease.  A  good  doctor  promises  no  cure,  only  to  do  his  best.  The 
poor  doctor  readily  promises ;  ignorant  people  want  a  man  who 
promises  to  cure. 

In  case  of  an  acute  attack,  perhaps  only  a  cold,  the  patient  may 
be  told  he  is  "threatened  with  pneumonia"  or  some  other  disease, 
but  the  threat  does  not  materialize.  What  was  really  the  matter 
and  what  was  the  cause  of  the  attack?  One  wonders,  especially  in 
cases  where  the  individual  in  a  day  or  two  is  out  on  the  street  again. 

One  of  my  old  patients  told  me  she  had  four  or  five  attacks  of 
diphtheria  in  so  many  years.  She  had  a  "sore  throat"  the  first 
winter  she  was  my  patient;  cautioned  about  the  influence  of  bad 
air  she  had  no  other  attack  for  several  years.  (She  was  a  dust 
victim.) 

There  are  various  reasons  why  people  get  such  explanations  or 
diagnoses,  which  however  are  not  real  diagnoses.  For  one  thing 
people  are  not  willing  to  have  the  physician  investigate  properly 
and  make  explanations  that  explain.  People  are  usually  willing 
to  pay  for  medicine  but  not  for  advice  and  where  competition 
among  practitioners  is  keen  a  doctor  can  not  afford  to  make  lengthy 
explanations.  Then  there  are  practitioners  who  are  too  lazy  to  in- 
vestigate. A  patient  may  drift  around  until  he  reaches  a  man  who 
does  investigate  and  finds  and  makes  the  right  explanation,  one 
that  is  fully  verified  in  the  course  of  time,  and  then  such  individu- 
als are  taken  out  of  the  drifting-about  class.  Then  too  there  are 
practitioners  who  are  not  above  scaring  people  in  order  to  get  them 


INTRODUCTORY.  39 

to  take  treatment.  They  usually  are  of  the  busy  kind,  so  "busy" 
that  they  have  no  time  to  belong  to  a  good  medical  society,  or  if 
they  nominally  belong,  never  take  part  in  discussions. 

Old  chronics  who  have  "made  the  rounds"  of  course  have  met 
all  sorts  of  doctors  and  when  one  questions  them  one  gets  all  sorts 
of  information  regarding  the  practices  of  "medicine  men,"  reg- 
ular and  irregular,  licensed  and  unlicensed,  including  the  "fly-by- 
night"  who  comes  to  town  and  announces  his  wonderful  accomplish- 
ments in  the  newspapers  but  in  a  short  time  disappears,  and  also 
the  quack  who  diagnoses  and  prescribes  by  mail,  and  the  druggist 
who  prescribes  over  the  counter,  and  the  faith  healer  who  gives 
"absent  treatment." 

The  subject  of  "newspaper  medicine"  is  an  interesting  one. 
Under  this  term  is  understood  the  alliance  of  the  newspapers  with 
"medicine  men"  who  may  not  at  all  be  physicians  or  who  are  not 
in  contact  with  the  regular  profession.  Patent  medicine  men  may 
not  be  doctors  at  all ;  they  are  usually  shrewd  business  men.  Quacks 
and  charlatans  may  have  medical  degrees,  even  a  license,  but  they 
are  pariahs  not  recognized  by  the  profession.  To  all  these  the  news- 
papers are  important.  In  other  words,  the  newspapers  help  these 
"medicine  men"  to  humbug  the  people.  I  shall  have  something 
to  say  about  these  further  on. 

As  already  mentioned,  everybody  has  an  explanation  or  wants 
one.  Some  explanations  are  simple,  others  complex.  Doctors  them- 
selves have  explanations  for  use  in  speaking  with  their  patients, 
but  perhaps  a  wholly  different  one  in  discussion  among  themselves, 
or  when  about  to  sign  a  death  certificate.  There  are  some  diseases 
from  which  respectable  people  do  not  die — only  poor  people  or 
those  without  friends  or  relatives.  Again,  some  explanations  of 
ill  health  may  be  considered  "fashionable,"  but  when  too  freely 
used  lose  cast.  The  diagnosis  of  "neurasthenia,"  for  instance,  was 
a  fashionable  one  until  too  many  poor  people  also  had  it.  "Neu- 
rasthenia" has  many  synonyms;  one  may  be  applied  more  appro- 
priately than  another. 

Another  explanation  in  vogue  a  decade  or  two  ago  was  "uric 
acid  in  the  blood."    This  explanation  was  widely  used  by  physi- 


40  DUSTY    AIR   AND    ILL   HEALTH. 

cians  but  has  now  been  practically  abandoned.  It  still  lives  on 
among  the  people,  kept  up  through  the  advertisements  of  patent 
medicine  men,  with  some  of  whom  uric  acid  in  the  blood  is  the 
foundation  for  practically  all  the  common  ills. 

The  explanations  of  physicians  differ  from  those  of  the  laity  in 
that  they  are  based  on  a  larger  number  of  cases.  A  sick  man  may 
know  of  very  few  cases.  The  theories  of  scientists  are  also  expla- 
nations. If  a  theory  explains  many  facts  and  can  be  used  in  pre- 
dicting it  may  form  a  " working  theory,"1  to  be  used  until  a  better 
explanation  is  found.  Each  change  likely  means  a  nearer  approach 
to  the  truth.  Perhaps  it  should  be  added  that  some  theories  or 
explanations  are  wholly  devoid  of  any  connection  with  dollars  and 
cents — but  old  medical  theories  may  still  be  used  on  account  of 
their  financial  importance.  The  "uric  acid  theory"  is  still  of  finan- 
cial use  to  patent  medicine  men. 

More  recently  another  explanation  for  much  of  the  common  ill 
health  has  come  into  use,  the  theory  of  auto-intoxication,  and  here 
too  the  patent  medicine  men  are  catching  on. 

Occasionally  the  physician  meets  individuals  who  state  their 
symptoms  and  assume  that  some  disease  is  present  but  say,  I  don 't 
know  what  it  is.  Often  such  persons  have  made  the  rounds  of  the 
doctors  and  have  had  all  sorts  of  opinions  and  finally  they  come 
to  believe  in  none,  and  being  unable  to  arrive  at  any  conclusions 
from  their  own  observations,  they  naturally  say,  "I  do  not  know 
what  it  is."  They  may  not  want  any  more  opinions;  they  want  to 
be  cured  or  have  symptoms  reduced  to  a  minimum.  Some  physi- 
cians like  to  get  hold  of  such  individuals  and  "work  out  the  case" 
as  they  would  any  other  problem. 

Now  those  in  ill  health  soon  discover  that  doctors  differ  greatly, 
that  they  are  interested  in  some  kinds  of  cases  and  some  people  but 
not  in  others.  A  specialist  is  interested  only  in  a  certain  kind  of 
cases,  he  may  wholly  refuse  to  take  an  interest  in  others.  The 
general  practitioner  is  supposed  not  only  to  be  interested  in  every 


1  Some  of  my  patients,  e8pecially!old|onesjwho^havelbeentwith*me!for  a  long  time,  speak  of  the  subject  as 
discussed  in  this  volume  as  the  "dust  theory."  They  are  firmly  convinced  of  its  truth.  The  reader  must  him- 
self determine  to  what  extent  it  is  a  "working  theory." 


INTRODUCTORY.  41 

case,  in  every  individual  who  applies  to  him,  but  to  know  just  how 
to  treat  the  almost  innumerable  kinds  of  diseases,  maladies,  dis- 
orders and  states  of  ill  health.  Does  he?  By  no  means.  The  "in- 
teresting case"  of  one  physician  or  surgeon  or  specialist  may  be  of 
no  interest  to  another;  if  he  gives  any  attention  at  all  it  may  be 
purely  of  a  routine  kind.  He  may  not  make  a  proper  study  of  the 
case  according  to  the  present  state  of  medical  science. 

Our  age  has  been  characterized  as  a  mercenary  one,  that  a  man 
will  do  nothing  unless  "there  is  money  in  it  for  me,"  and  phy- 
sicians have  not  escaped  the  accusation.  In  olden  times  physicians 
depended  on  an  honorarium ;  they  left  the  matter  of  pay  to  their 
patients.  The  medical  profession  has  always  been  a  poorly  paid 
one.  Unlike  lawyers,  physicians  do  not  ask  for  a  contingent  fee 
and  only  too  often  there  is  no  clear  understanding  of  what  they 
are  to  get  in  return  for  services.  In  Europe  and  in  all  countries 
where  people  are  not  much  given  to  moving  about,  people  learn  to 
know  to  what  extent  to  depend  upon  one  another,  the  physician 
may  be  willing  to  give  unlimited  credit.  But  in  our  country  where 
people  are  constantly  on  the  move  unlimited  credit  is  not  feasible. 
The  telephone  company  collects  in  advance.  The  grocer  wants 
prompt  pay.  The  newspapers  send  out  their  collectors  at  the  end 
of  the  month.  Even  physicians  have  found  it  imperative  to  look 
after  prompt  collections.  Just  as  the  grocer  will  not  trust  and  the 
newspaper  will  not  trust,  so  many  physicians  will  not  trust.  If  a 
man  has  nothing  to  give  in  return  he  is  probably  given  scant  at- 
tention. A  physician  may  be  so  overloaded  with  poor  patients  that 
he  can  not  make  a  decent  living — and  yet  the  stranger  in  acute 
distress  will  likely  receive  attention  without  question,  "according 
to  the  traditions  of  the  profession." 

Medicine  is  an  evolution.  Fortunately  (or  shall  we  say  unfor- 
tunately?) there  is  no  tradition  regarding  what  the  "laboratory 
doctor"  should  do  in  the  case  of  applicants,  especially  where  the 
applicant  is  an  old  chronic  and  where  there  is  no  emergency.  The 
student  of  chronic  ill  health  may  make  all  sorts  of  inquiries,  includ- 
ing what  he  is  to  get  in  return  for  his  services,  before  he  accepts  a 
new  patient. 


42      /"  DUSTY    AIR    AND   ILL   HEALTH. 

If  the  good  physicians  were  less  backward  and  the  poor  ones, 
especially  the  advertising  quacks,  were  less  forward  in  speaking 
about  fees,  and  if  people  clearly  understood  that  the  laborer  is 
worthy  of  his  hire,  there  would  soon  be  a  change. 

What  many  of  those  in  chronic  ill  health  and  especially  poor 
people  need  is  good  advice.  Many  ills  are  not  curable  by  the  taking 
of  a  "little  medicine."  But  good  advice  means  investigation  and 
that  means  to  take  up  a  lot  of  time  and  time  must  be  paid  for.  The 
physician  who  practices  medicine  purely  from  the  humanitarian 
standpoint  is  an  exceptional  individual ;  few  can  afford  to  do  it. 

If  the  old  chronics  are  neglected  by  the  physician,  if  they  get 
only  routine  attention,  "a  lick  and  a  promise,"  what  do  they  do? 
For  one  thing  they  buy  patent  medicines.  Having  tried  all  doc- 
tors and  all  the  advertised  nostrums  and  finding  themselves  still 
uncured,  they  are  ready  to  try  everything  else,  even  faith  and  mind 
cures. 

Now  according  to  my  experience  (and  I  have  given  the  subject 
of  chronic  ill  health  much  attention)  many  individuals  who  are 
complaining  are  not  really  "diseased,"  they  are  merely  reacting 
to  an  unsanitary  environment,  one  to  which  they  are  not  adapted. 
Much  of  the  prevalent  ill  health  in  reality  is  due  to  the  ' '  influence 
of  environment,"  it  is  a  reaction  to  unsanitary  conditions.  Such 
ill  health  is  not  curable  by  the  taking  of  drugs  nor  any  outlandish 
mode  of  treatment.  Change  of  environment  or  change  in  habits 
may  be  the  cure,  that  is,  cause  symptoms  to  disappear.  Symptoms 
like  everything  else  have  a  cause ;  by  removing  the  cause  they  dis- 
appear. Symptoms  are  to  be  regarded  as  warnings;  they  are  to 
be  heeded.  There  is  something  wrong.  The  automobilist  when  he 
hears  any  peculiar  noise  about  his  machine  knows  there  is  some- 
thing wrong.  Pains  and  aches  are  nature's  way  of  letting  us  know 
something  is  wrong  with  the  human  machine.  The  doctor  who  tells 
a  patient  to  neglect  symptoms  and  tells  him  not  to  worry  is  not  apt 
to  be  a  student  of  common  ill  health,  and  the  people  soon  discover  it. 

There  is  a  vast  difference  in  attempting  to  explain  a  man's 
ill  health  (symptoms  of  ill  health)  in  the  light  of  postmortem 
pathology  or  in  the  light  of  the  "pathology  of  the  living,"  between 


INTRODUCTORY.  43 

attempting  to  trace  ill  health  to  the  presence  of  some  well-defined 
disease  or  to  the  influence  of  an  unsanitary  environment.  Some 
explanations  do  not  appeal  to  patients,  the  explanation  may  be 
the  correct  one  or  not.  Although  it  may  take  much  time  to  inves- 
tigate, it  may  take  more  time  to  make  proper  explanations  so  that 
the  patient  will  understand.  Some  cases  the  physician  can  readily 
explain,  that  is  to  his  own  satisfaction,  he  may  have  seen  many 
cases  of  the  same  kind;  but  at  times  it  is  a  problem  how  to  make 
explanations  that  make  the  subject  clear  to  the  patient.  Other 
things  being  equal,  the  patient  who  most  fully  comprehends  will 
likely  most  fully  co-operate. 

Old  chronics  as  a  rule  have  had  all  sorts  of  advice;  they  may 
have  been  to  specialists  who  insist  on  the  importance  of  one  thing 
or  another,  but  according  to  my  experience  the  man  who  has  been 
advised  regarding  a  neglected  factor,  bad  air,  is  very  exceptional. 

The  subject  of  ill  health,  especially  chronic  ill  health,  can  be 
studied  from  different  standpoints.  Here  I  shall  pursue  it  (as 
may  have  been  suspected  from  the  tone  of  this  introductory)  from 
the  standpoint  of  air  conditions.  Man  eats  about  three  times  a 
day;  he  drinks  perhaps  five  times  a  day  on  the  average,  but  he 
breathes  fifteen  to  eighteen  times  a  minute.  He  can  do  without 
food  many  days;  he  can  do  without  drink  for  several  days,  but  he 
can  do  without  breathing  for  only  a  few  minutes.  A  farmer  or 
a  suburbanite  can  go  to  the  city  without  eating  or  drinking  but 
he  can  not  do  without  breathing.  He  can  avoid  sickness  and  ill 
health  due  to  food  or  drink,  but  he  may  be  wholly  unable  to  avoid 
ill  health  due  to  breathing  bad  air.  If  he  knows  what  bad  air  is 
and  chooses  to  remain  away  from  it,  he  may  escape.  In  this  work 
I  purpose  to  point  out  what  is  meant  by  good  and  bad  air  and  the 
kind  of  ill  health  that  may  be  caused  by  it. 

After  a  physician  has  given  a  subject  attention  for  years  and 
has  seen  hundreds  of  cases  and  had  innumerable  discussions  with 
patients  on  all  sorts  of  topics  relating  to  common  ill  health  and 
more  particularly  on  ill  health  traceable  to  air  conditions,  it  be- 
comes a  problem  what  to  include  and  what  to  exclude  from  a  book 


44  DUSTY   AIR   AND   ILL   HEALTH. 

for  the  general  reader.  Of  necessity  one  must  confine  himself  to 
more  or  less  general  statements,  unusual  or  rare  cases  can  not  be 
cited  at  all,  neither  can  one  go  into  details  that  may  be  of  interest 
only  to  the  few.  The  subject  is  really  a  vast  one  and  some  things 
can  not  be  taken  up  at  all,  some  only  very  briefly.  It  is  hoped 
enough  is  given  to  enable  the  intelligent  reader  to  arrive  at  some 
conclusions. 

It  may  be  proper  here  to  say  that  those  who  have  never  given 
the  subject  of  dust  influences  and  dust  infection  any  attention 
may  view  this  subject  with  alarm.  They  may  think  we  are  threat- 
ened with  a  new  peril.  Every  now  and  then  we  see  accounts  by 
some  alarmist  of  some  "chief  peril"  that  threatens  destruction  to 
the  nation — and  yet  the  world  lives  on. 

When  the  germ  theory  was  first  advanced  timid  people  saw 
germs  everywhere ;  they  became  fearful.  In  time  they  learned  that 
only  certain  kinds  are  injurious  and  that  their  destructive  in- 
fluences are  limited.  We  have  learned  where  to  expect  them  and 
to  know  where  they  are  not  apt  to  occur.  The  same  may  be  said 
of  dust.  Only  certain  kinds  of  dust  are  injurious  and  when  we 
learn  where  these  occur  and  where  not  we  may  find  there  is  no 
need  to  be  alarmed.  Prudent  people  know  that  to  be  forewarned 
is  to  be  forearmed;  they  also  know  that  there  are  those  who  are 
heedless  and  as  a  consequence  suffer. 


II 

LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.1 

(Mesology  and  Ecology.) 


Changes  in  my  own  State  have  been  discussed  with  many  pa- 
tients, particularly  with  old  people,  early  settlers.2  The  present 
generation,  especially  people  living  under  city  conditions,  has  little 
idea  of  the  early  conditions  under  which  people  live  and  of  the 
changes  that  have  taken  place  since  clearing  the  forests  and  drain- 
ing the  wet  lands  and  building  towns  and  cities.  To  understand 
present  complex  conditions  we  must  study  earlier  simpler  condi- 
tions. 

Indiana  like  surrounding  states  lies  in  the  north  temperate 
zone  and  has  an  annual  variation  of  temperature  of  approximately 
125  degrees,  from  25  below  zero  to  100  above.  On  account  of  the 
fairly  equal  distribution  of  rainfall  (about  40  inches  a  year)  there 
is  an  abundant  supply  of  water  for  man  and  beast  and  plants. 
When  the  white  man  first  came  to  what  is  now  Indiana,  dense  for- 
ests covered  the  country  except  parts  of  the  northern  level  marsh 
and  prairie  land.  In  a  general  way  it  may  be  said  that  the  south- 
ern third  of  our  State  is  hilly,  the  central  slightly  rolling,  while 
the  northern  third  is  flat  and  wet,  but  recently  modified  greatly 
by  drainage. 

Natives.  Our  State  when  the  white  man  first  came  in  was  in 
possession  of  the  American  Indians.  They  were  still  in  the  hunt- 
ing and  fishing  stage  of  civilization.  They  were  a  "strong  and 
healthy  race,"  mainly  on  account  of  their  simple  life  and  because 
not  exposed  to  the  active  causes  of  diseases ;  they  lived  in  isolation. 

1  The  original  title  of  this  chapter  was  CHANGES  IN  INDIANA,  but  manuscript  critics  objected, 
saying  that  that  would  give  the  reader  the  impression  that  the  volume  was  local,  that  the  conditions 
described  existed  only  in  Indiana,  while  in  reality  similar  changes  occur  in  surrounding  States  and  in 
fact  all  over  the  United  States. 

Here  I  am  merely  writing  about  things  I  know  and  have  discussed  with  patients.  The  French 
have  a  saying,  He  may  lie  boldly  who  comes  from  afar.  The  reader  in  a  distant  country  may  regard 
some  of  my  descriptions  as  imaginary  but  my  patients  know  they  are  true.  To  what  extent  descriptions 
and  conditions  apply  to  other  localities  the  reader  must  determine  for  himself. 

2  I  have  already  referred  to  an  old  farmer  and  his  ideas  on  the  changes  in  diseases  and  climate. 

(45) 


46  DUSTY   AIR    AND   ILL   HEALTH. 

Early  Immigrants.  These  were  French  hunters  and  trappers, 
roaming  over  the  country.  They  were  soon  followed  by  people  of 
English  descent,  The  history  of  the  white  man  in  this  State  goes 
back  a  little  over  two  hundred  years. 

Early  Settlers.  The  first  "foreigners"  who  came  to  make 
this  State  their  home  were  the  French,  settling  along  the  lower 
Wabash  river.  They  settled  in  communities,  thus  differing  from 
people  of  other  European  countries,  especially  the  British  who  took 
to  the  open  country.  The  latter  came  in  two  main  streams,  one 
from  the  south,  composed  mainly  of  descendants  of  southern  moun- 
taineers, the  other  from  the  east,  mainly  descendants  of  Atlantic 
colonists.     In  time  people  came  here  direct  from  Europe. 

An  interesting  study  is  that  of  motives  that  prompt  people  to 
leave  their  ancestral  homes  and  seek  out  a  new  home  in  the  wilder- 
ness. The  early  English  immigrants  to  this  country  seem  to  have 
left  their  old  homes  mainly  on  account  of  religious  restrictions. 
They  wanted  to  worship  in  their  own  way — and  yet  as  soon  as  they 
attained  their  end  they  tried  to  force  others  to  do  as  they  did; 
they  became  more  oppressive  than  their  own  oppressors.  For  this 
reason  again  many  early  settlers  in  the  New  England  States  went 
still  further  west. 

"Natives."  The  term  "natives"  is  frequently  heard,  especi- 
ally by  the  descendants  of  the  early  comers  in  contrasting  them- 
selves with  recent  arrivals — but  at  the  rate  they  are  dying  off  or 
rather  not  propagating  themselves  they  will  soon  be  extinct,  es- 
pecially under  unsanitary  city  conditions.  Then  we  must  consider 
the  fact  that  this  "native"  blood  is  constantly  being  diluted  by 
intermarriage  with  "foreigners,"  with  new  arrivals. 

Other  Nationalities.  Immigrants  from  other  countries,  from 
Germany,  Ireland,  Sweden,  from  Italy,  etc.,  began  to  come  early 
but  only  recently  in  large  numbers,  comparatively  speaking.  In 
proportion  as  immigration  from  northern  European  countries  di- 
minished, that  from  the  southern  countries  increased.  The  motive 
that  impels  most  new  comers  seems  to  be  easier  life  conditions 
existing  here,   escaping  overcrowded  European  conditions.     But 


LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.  47 

since  practically  all  public  land  is  now  taken  up  many  of  these 
come  to  our  cities  only  to  lead  a  mere  struggle  for  existence. 

Other  Races.  The  white  man  was  followed  by  other  races. 
First  came  negroes,  brought  in  as  slaves.  In  recent  years  Chinese 
and  Japanese  have  come  in.  But  our  State  at  present  is  essentially 
peopled  by  the  descendants  of  immigrants  from  Great  Britain  and 
Germany,  with  a  fair  sprinkling  of  other  nationalities. 

The  first  white  men  coming  to  our  State  were  hardy  specimens. 
The  weak  and  decrepit  were  left  behind  or  perished  on  the  long 
overland  journey.  The  first  settlers  brought  in  few  goods,  simple 
household  utensils,  a  few  domestic  animals  and  seed  of  various 
plants.  Life  at  first  was  very  simple,  especially  as  long  as  game 
lasted.    A  small  truck  patch  supplied  the  table. 

Another  Kind  op  Immigrant.  In  time  all  kinds  of  "immi- 
grants" came,  the  Old  World  pests  and  parasites.  The  European 
rat  came  in  early.  European  weeds1  of  all  kinds  came  in  gradually 
and  compelled  the  settler  or  farmer  to  war  against  them.  These 
weeds  have  for  years  resisted  destruction  at  the  hands  of  man  and 
have  developed  staying  qualities.  They  rapidly  crowd  out  native 
plants  and  if  not  kept  down  also  crowd  out  cultivated  plants,  just 
as  the  white  man  crowds  out  the  native  Indians. 

Besides  a  host  of  animal  parasites  varying  from  quadrupeds 
down  to  insects  that  attack  crops,  there  have  come  in  a  variety  of 
rusts  and  blights  that  attack  the  farmer's  grains  and  trees.  Just 
as  in  the  case  of  new  weeds,  rusts  and  blights2  are  constantly  com- 
ing in,  often  producing  serious  damage. 


1  Several  years  ago  on  a  tour  through  the  Yellowstone  National  Park  I  was  surprised  to  find  an 
almost  complete  absence  of  our  common  weeds,  weeds  that  originally  came  from  Europe.  Only  a 
short  time  ago  a  friend  told  me  of  a  man  here  on  a  visit  from  the  Saskatchewan  who  gave  a  glowing 
account  of  the  large  crops  raised  and  the  immense  size  of  potatoes,  cabbages  and  turnips.  He  ascribed 
it  to  the  climate,  while  as  a  matter  of  fact  it  was  due  to  the  virgin  soil  and  the  absence  of  common 
weeds  which  had  not  yet  come  in  and  warred  with  cultivated  plants  for  possession  of  the  soil. 

2  Our  State  Agricultural  College  is  studying  this  subject.  A  friend  periodically  sends  me  a  blank 
to  fill  out  regarding  the  ravages  of  rusts  and  blights  in  the  county  but  unfortunately  I  know  so  little 
about  such  things  that  I  can  be  of  little  service.  If  I  did  report  without  knowing  the  real  facts  I  might 
be  misleading  those  who  are  supposed  to  know;  hence  I  prefer  not  to  report  at  all.  But  I  am  ready 
and  willing  to  gather  and  send  material,  specimens,  that  will  enable  these  who  do  know  how  to  determine 
the  facts  in  the  case. 


48  DUSTY   AIR   AND   ILL   HEALTH. 

Other  Parasites.  As  already  mentioned  the  native  Indians 
were  strong  and  healthy.  The  first  immigrants  were  also  a  hardy 
race,  they  left  their  diseased  and  diseases  behind.  Now  every  stu- 
dent of  nature  knows  that  human  beings  are  afflicted  by  various 
parasites,  just  as  animals  and  plants  are,  and  that  it  is  only  a 
matter  of  time  until  many  come  to  a  community  where  they  had 
never  been  seen  before.  Many  diseases  of  man  are  due  to  the  pres- 
ence of  parasites,  both  animal  and  vegetable.  The  first  appearance 
of  many  of  these  parasites,  and  that  means  the  resulting  diseases, 
is  known ;  there  is  a  record  in  the  books  or  journals.  Some  para- 
sites are  large  enough  to  be  seen  by  the  unaided  eye;  others  are 
so  minute  that  they  must  be  highly  magnified.  The  active  causes 
of  such  diseases  as  typhoid  fever,  cholera,  tuberculosis,  malaria, 
are  very  minute,  but  they  make  up  in  number  what  they  lack  in 
size ;  they  may  simply  overpower  the  body ;  then  we  say  the  disease 
killed. 

Some  of  the  now  common  diseases  came  in  early.  There  is  for 
instance  a  history  of  smallpox  brought  in  by  the  French  and  killing 
off  many  Indians.  The  Indians  never  having  had  such  a  disease 
proved  very  susceptible  and  died  off  in  great  numbers.  Similarly 
when  tuberculosis,  or  consumption,  was  brought  in  to  them  they 
died  off  at  a  great  rate.  Unfortunately  there  are  few  records  of 
the  appearance  of  many  of  the  common  diseases  in  our  State  and 
there  are  no  records  of  the  sort  of  specific  diseases  the  Indians  had 
before  the  time  of  the  white  man's  first  coming  among  them. 

Diseases  and  Their  Causes.  There  are  all  sorts  of  diseases 
as  there  are  all  kinds  of  causes,  native  and  foreign,  internal  and 
external.  It  may  be  said  that  a  disease  is  a  reaction  of  the  body 
toward  a  cause  and  that  the  reaction  depends  upon  the  kind  of 
cause.  Some  causes  produce  a  mere  disturbance  or  malaise,  others 
ill  health,  still  others  produce  a  reaction  so  severe  that  it  kills 
quickly.  Many  of  the  active  causes  of  disease  when  growing  in 
the  body  produce  poisons  and  these  poisons  act  upon  the  body; 
this  reaction  is  termed  specific  disease. 

Many  substances  when  they  gain  entrance  into  the  system  bring 


LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.  49 

on  a  reaction  that  is  characteristic.  Thus  when  lead  gets  into  tin; 
body  there  results  lead  poisoning  or  plumbism,  a  disease  that  oc- 
curs especially  among  lead  workers  and  painters.  Now  we  are 
reasonably  safe  in  asserting  that  before  the  advent  of  the  white 
man  the  Indian  knew  nothing  about  lead  and  he  was  free  from  lead 
poisoning,  just  as  he  was  free  from  morphinism  and  alcoholism, 
and  in  all  probability  he  likewise  escaped  poisoning  by  the  activity 
of  the  typhoid  bacillus  and  the  tubercle  bacillus ;  they  had  not  yet 
been  introduced. 

One  need  scarcely  go  into  a  discussion  of  the  active  causes  of 
diseases  to  which  the  Indian  was  subject.1  They  were  relatively 
few.  Among  native  causes  one  is  apt  to  think  of  the  pollen  of  Rag 
weed  or  Goldenrod;  one  wonders  whether  the  Indians  had  "hay- 
fever."  But  at  least  one  "native  disease"  should  be  mentioned, 
namely,  milk  sickness;  this  severely  attacked  the  first  settlers,  kill- 
ing many;  it  has  now  practically  disappeared.  Whether  malaria 
existed  among  the  Indians  before  the  white  man  came  is  very 
doubtful.  It  seems  to  have  come  in  some  time  after  the  white  man 
and  soon  became  a  serious  and  fatal  disease.  But  in  time  as  the 
State  settled  up  and  wet  lands  were  drained  it  became  less  and  less 
common  until  now  it  is  a  comparatively  rare  disease.  (The  term 
malarial  so  frequently  used  at  the  present  time  as  a  rule  has  noth- 
ing whatever  to  do  with  malarial  fever.  Recently  it  has  been  pro- 
posed to  rename  malaria  Anophelesis,  because  it  is  transmitted 
through  the  bite  of  the  Anopheles  mosquito.) 

Occupation,  III  Health,  Disease.  There  is  a  close  relation- 
ship between  the  occupation  of  an  individual  and  the  amount  and 
kind  of  his  ill  health  and  disease.  The  native  Indians  were  hunters 
and  fishers  and  moved  about  constantly ;  they  led  an  active  out-of- 
door  life ;  they  had  pure  water,  pure  food  and  pure  air  and  came 
little  in  contact  with  diseased  people  and  hence  were  "healthy." 
We  should  keep  clearly  in  mind  that  "healthy"  under  such  con- 
ditions is  the  result  of  not  coming  in  contact  with  the  causes  of  ill 
health  and  disease. 


1  The  Indians  of  today  can  no  longer  be  regarded  as  "primitive  people,"  for  they  have  been  exposed 
to  all  kinds  of  introduced  diseases  and  there  is  more  or  less  "mixed  blood"  among  them. 

[41 


50  DUSTY    AIR    AND   ILL    HEALTH. 

The  first  white  men,  as  already  mentioned,  were  also  hunters 
and  trappers.  Leading  a  simple  life  after  the  manner  of  the  Indian. 
They  had  no  fixed  homes.  They  likewise  were  "healthy,"  or,  as 
we  commonly  say,  hardy.  The  settlers,  in  distinction  to  the  hunters 
and  trappers,  were  accompanied  by  their  wives  and  children ;  they 
established  homes  and  that  means  more  or  less  exchanged  an  out- 
door life  for  an  indoor  one.  This  means  that  the  sick  were  housed 
up  and  kept  alive  as  long  as  possible,  and  it  means  too  that  the 
healthy  constantly  came  in  contact  with  the  sick  and  with  the 
causes  of  sickness  and  disease.  Many  diseases  keep  themselves 
alive,  so  to  speak,  by  wandering  from  one  individual  to  another, 
and  in  proportion  as  the  healthy  are  exposed  to  the  sick  the  oppor- 
tunities for  such  propagation  are  favorable.  The  Indian  with  no 
fixed  home  neglected  his  sick  and  they  quickly  perished,  just  as  the 
sick  of  the  white  man  perished  on  the  long  march  to  the  new  home. 
Some  diseases  may  be  regarded  as  house  diseases,  notably  tubercu- 
losis ;  they  do  not  thrive  among  open  air  people. 

The  susceptibility  to  ill  health  and  disease  varies  greatly,  as  we 
all  know.  Some  succumb  readily,  others  are  highly  resistent.  This 
depends  partly  on  a  more  or  less  close  contact  with  the  sick  and 
partly  on  the  ancestral  history.  When  the  ancestors  had  for  ages 
been  exposed  to  a  disease  the  very  susceptible  were  constantly 
killed  off,  the  survivors  being  more  or  less  resistent.  One  might 
say  there  is  more  or  less  adaptation  toward  the  disease  and  the 
people  among  whom  the  disease  lives.  If  a  disease  is  so  severe 
that  it  kills  off  all  the  people  of  a  region  then  the  disease  itself 
perishes  for  want  of  material.  If  on  the  other  hand  it  is  not  strong 
enough  to  attack  some  of  the  people  then  it  also  perishes  or  dis- 
appears. If  the  descendants  of  highly  resistent  people  go  to  an 
isolated  region  where  they  are  not  constantly  exposed  to  the  rav- 
ages of  disease  they  reach  maturity  and  leave  offspring  that  in 
time  becomes  susceptible,  that  is  on  coming  in  contact  with  dis- 
eases. There  is  no  weeding  out  until  the  individuals  come  in  con- 
tact with  diseases  that  cause  a  weeding  out.  This  explains  why 
the  descendants  of  southern  mountaineers  are  so  susceptible  to 
many  of  our  common  diseases  on  leaving  their  mountain  or  good 


LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.  51 

air  homes.  The  usual  but  erroneous  explanation  is  that  they  "lack 
stamina;"  as  a  matter  of  fact  they  have  not  been  exposed  to  dis- 
ease and  there  has  been  no  weeding  out.  To  exchange  an  out-of- 
door  life  for  an  indoor  one  or  exchange  an  isolated  country  life  for 
a  complex  city  one  means  that  many  will  be  weeded  out. 

This  weeding-out  process  occurs  everywhere,  even  among  plants. 
Every  now  and  then  some  blight  or  rust  gets  among  cultivated 
plants  and  destroys  them.  Perhaps  a  few  out  of  a  large  field  sur- 
vive and  the  plant  breeder  by  saving  the  seed  of  these  in  time 
produces  a  "disease  proof,"  i.  e.,  rust  or  blight  proof,  variety  to 
take  the  place  of  the  other,  the  susceptible  kind.  Thus  we  have 
the  present  "rust  proof  oats"  and  many  disease  and  rust  and 
blight  proof  fruits  and  vegetables.  The  naturalist  would  say  they 
are  the  survival  of  the  fittest.  There  is  increasing  difficulty  in 
raising  many  plants  on  account  of  the  appearance  of  all  kinds  of 
plant  diseases. 

Many  if  not  most  domesticated  plants  and  animals  would  quickly 
perish  if  left  to  nature ;  they  are  not  adapted.  Chickens  and  geese 
unable  to  fly  would  fall  a  prey  to  their  enemies,  especially  to  the 
fox.  A  cow  without  powerful  horns  would  fall  a  prey  to  the  wolf. 
The  seed  of  plants  such  as  corn  and  melons  would  not  "winter 
over."  It  is  man  who  makes  the  conditions  for  their  existence 
possible,  just  as  he  makes  conditions  for  his  own  existence  favor- 
able. To  neglect  sanitation  in  large  cities  would  mean  that  the 
inhabitants  would  die  off  in  vast  numbers  from  epidemic  diseases; 
we  need  only  keep  in  mind  how  Asiatic  cholera  and  the  Bubonic 
plague  are  kept  out  of  the  country  or  kept  under  control. 

Occupations  and  Meeting  Places.  It  would  be  interesting  to 
follow  up  the  different  occupations  taken  up  in  our  State  in  the 
course  of  time,  beginning  with  that  of  hunting  and  trapping  and 
followed  by  farming.  Perhaps  the  first  differentiation,  that  is  the 
first  sedentary  occupation,  was  that  of  store-keeper,  the  man  who 
supplied  the  simple  wants  of  the  settlers,  taking  in  return  the 
produce  of  woods  and  fields.  From  the  standpoint  of  the  evolu- 
tion of  diseases,  one  may  say  that  the  store  is  an  important  factor 


52  DUSTY    AIR    AND    ILL   HEALTH. 

because  it  formed  a  meeting  place  for  all  sorts  of  individuals.  On 
long  winter  evenings  the  men  crowded  about  the  stove  to  exchange 
stories,  at  the  same  time  smoking  and  chewing  and  spitting.  Un- 
der such  conditions  the  germs  of  disease  are  readily  transmitted 
from  one  to  another. 

The  preacher  too  came  in  early  and  churches  were  built,  and 
that  means  that  another  place  for  the  propagation  and  exchange  of 
diseases  was  established ;  the  sick  and  the  healthy  met.  One  may 
say  that  in  proportion  as  there  was  poor  ventilation  the  chances  of 
transmitting  diseases  were  increased.  Some  churches  are  not 
opened  from  one  Sunday  to  another. 

Trades  came  in  gradually.  The  blacksmith  early  set  up  his 
forge  in  the  new  settlement.  "The  butcher,  the  baker,  the  candle- 
stick maker"  all  followed  in  time,  as  the  country  grew.  The  ad- 
vent of  steam  led  to  the  formation  of  industrial  communities,  of 
factory  towns,  with  men  confined  indoors,  often  under  very  bad 
sanitary  surroundings  all  day  long.  Some  parents  have  an  idea 
that  their  weak  or  delicate  children  should  take  up  some  indoor 
occupation,  that  they  are  not  strong  enough  to  be  "exposed;"  what 
they  may  really  require  is  an  outdoor  occupation. 

Schools  are  places  where  children  congregate.  They  came  in 
early.  Here  we  have  the  great  agency  for  the  spread  of  diseases 
among  children,  the  children  from  the  homes  of  the  well  or  healthy 
coming  in  contact  with  the  sick  and  diseased.  Even  today  the 
annual  fall  opening  of  the  schools  is  followed  by  a  great  increase, 
often  an  epidemic,  of  certain  diseases.  Children  may  take  infec- 
tion home  to  their  parents. 

Every  county  has  its  court  house  and  this  again  is  a  meeting 
place  for  the  people  of  a  large  area.  The  poor  ventilation  and 
unsanitary  condition  of  many  court  houses  are  notorious.  One  can 
readily  see  how  a  court  house  may  form  a  focus  for  the  dissemina- 
tion of  diseases  among  country  people.  When  a  small  community 
reaches  the  size  of  a  town  it  likely  has  its  opera  house.  Today  in 
addition  there  are  one  or  more  five  cent  theaters,  often  very  poorly 
ventilated,  regular  incubators  for  ill  health  and  disease,  as  many 
have  discovered  and  with  the  discovery  remain  away. 


LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.  53 

Disease  and  III  Health.  Disease  like  every  other  phenome- 
non in  this  world  has  a  cause.  In  the  absence  of  the  cause  the 
reaction,  that  is,  the  disease,  is  absent.  For  instance,  there  can 
be  no  alcoholism  in  the  absence  of  alcohol ;  there  is  no  typhoid  fever 
in  the  absence  of  the  bacillus  typhosus.  Often  the  relationship  is 
not  so  simple,  as  in  the  case  of  malaria,  which  on  the  one  hand 
requires  the  presence  of  the  active  cause  (a  plasmodium)  and  on 
the  other  the  presence  of  the  transmitting  agent  (a  certain  kind 
of  mosquito,  genus  Anopheles)  which  carries  the  disease  from  one 
to  another. 

Ill  health  scarcely  reaching  a  condition  or  stage  of  severity 
where  it  can  be  dignified  by  the  name  of  disease  is  largely  due  to 
environmental  influences,  that  is,  the  place  where  we  live  or  the 
conditions  under  which  we  live.  (The  coming  in  contact  with  the 
sick,  using  bad  food,  bad  water,  bad  air,  living  under  depressing 
conditions,  etc.,  all  are  factors.)  Ill  health  and  disease  of  course 
shade  off;  there  may  be  no  sharp  dividing  line. 

The  word  disease  is  in  the  mouth  of  everybody.  We  all  have 
some  idea  what  it  means.  Physicians  know  and  many  sick  know 
that  there  may  be  ill  health  and  yet  no  well-defined  disease,  just 
as  there  may  be  well-defined  disease,  especially  in  its  early  stages, 
and  yet  on  account  of  the  absence  of  symptoms  the  individual  may 
not  be  aware  of  it,  symptoms  may  appear  later.  One  may  argue, 
"If  there  are  no  symptoms  there  is  no  disease." 

The  body  reacts  to  all  sorts  of  causes,  material  and  immaterial. 
We  may  feel  bad  on  account  of  bad  news,  worry,  or  fright,  just  as 
we  may  feel  bad  by  using  improper  food  and  drink.  Food  may 
undergo  a  change  with  the  production  of  poisons  (as  ptomaines), 
and  the  reaction  may  be  a  poisoning,  perhaps  not  strong  enough 
to  kill  but  certainly  to  produce  ill  health  or  sickness.  Bad  water 
and  bad  air  are  often  a  cause  for  continued  ill  health,  not  to  speak 
of  definite  diseases.  The  causes  of  many  specific  diseases  have 
been  definitely  determined.  It  is  positively  known  that  in  the  ab- 
sence of  the  cause  there  can  be  no  disease,  just  as  a  field  will  be 
free  from  weeds  unless  seed  of  weeds  is  brought  in,  each  kind  re- 
producing itself  and  no  other.     But  strange  to  say  the  cause  of 


54  DUSTY    AIR    AND    ILL    HEALTH. 

much  common  ill  health  is  not  known.  In  fact,  ill  health  may  be 
due  to  a  great  variety  of  causes,  often  difficult  to  determine.  Here 
again  we  may  question  to  what  extent  common  ill  health  prevailed 
among  the  Indians  and  the  first  white  men. 

All  sorts  of  speculations  may  be  made  regarding  the  amount  of 
ill  health  dependent  upon  complex  life  conditions.  It  can  not  be 
too  strongly  emphasized  that  the  Indian  and  the  early  white  settler 
led  simple  lives,  coming  in  contact  with  few,  while  today  there  is 
a  many-sided  contact,  especially  among  city  people.  There  are 
even  individuals  who  have  come  from  far  away  countries  who  have 
brought  with  them  the  germs  of  foreign  diseases.  We  need  only 
think  of  our  soldiers  and  teachers  and  missionaries  in  the  Philip- 
pines bringing  in  new  and  strange  diseases.  Such  diseases  should 
be  carefully  studied  and  kept  under  observation  to  prevent  their 
spread.1  It  is  perhaps  unnecessary  to  say  that  tropical  diseases 
may  find  the  temperate  zone  as  unfavorable  for  their  propagation 
as  tropical  weeds  find  climatic  conditions  unfavorable.  Out  of  a. 
great  number  of  weeds  constantly  introduced  only  a  comparative 
few  are  able  to  maintain  themselves  in  the  new  environment  or 
climate.2 

If  we  were  to  review  the  different  diseases  known  to  occur  or 
to  have  occurred  in  Indiana  it  would  be  necessary  to  distinguish 
between  native  and  foreign  diseases,  just  as  we  must  distinguish 
between  native  and  foreign  plants  and  animals  and  native  and 
foreign  weeds  and  pests  and  parasites  of  all  kinds.  Unfortunately 
early  records  of  the  first  appearance  of  new  diseases  as  of  new 
weeds  and  parasites  are  scant.  Now  that  many  are  common  it  is 
difficult  to  determine  whether  they  were  natives  or  not.  The  first 
white  men  were  not  observers  or  if  so  left  no  records. 

The  first  medical  men  coming  into  our  State  were  army  sur- 

1  A  few  years  ago  I  had  an  opportunity  to  study  a  tropical  disease,  Psilosis,  in  a  missionary  returned 
from  Asia.  Fortunately  this  disease  did  not  spread,  perhaps  on  account  of  unfavorable  climatic 
conditions. 

2  While  keeping  track  of  new  plants,  mainly  weeds,  coming  into  Fayette  county  (Indiana),  from 
1883  to  1890,  especially  along  the  railroads,  I  was  interested  in  noting  that  out  of  thirty-five  new  arrivals 
only  nine  were  able  to  maintain  themselves  from  year  to  year,  and  that  not  more  than  half  a  dozen 
of  these  became  common  weeds.  (For  details  see  Proceedings  Indiana  Academy  of  Science,  1893, 
pp.  258-262.) 


LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.  55 

geons  and  they  left  scarcely  any  records.  It  should  be  borne  in 
mind  that  when  we  speak  of  a  new  disease  we  mean  an  old  disease 
in  a  new  locality,  just  as  a  new  weed  means  an  old  weed  now  for 
the  first  time  found  in  a  new  locality.  Many  old  diseases  are  still 
absent  in  certain  parts  of  the  world,  they  have  not  been  introduced 
Some  small  islands  are  still  free  from  a  number  of  the  common 
diseases  but  it  is  only  a  question  of  time  until  they  will  be  intro- 
duced. 

Disease  vs.  Ill  Health.  Well-defined  diseases  shade  off  into 
ill-defined  states  of  "ill  health"  where  one  can  hardly  speak  of 
"disease."  Diseases  like  conditions  of  ill  health  manifest  them- 
selves by  symptoms.  Is  a  slight  headache  a  disease,  a  condition  of 
ill  health,  or  only  a  symptom?  If  stomach  distress  is  persistent, 
or  recurs  frequently,  we  may  speak  of  ill  health,  and  yet  the  best 
medical  skill  may  be  unable  to  diagnose  the  presence  of  disease. 
Common  stomach  disturbances  are  commonly  called  "dyspepsia," 
due  perhaps  to  one  or  several  of  a  great  variety  of  causes,  as  im- 
proper food,  spoiled  food,  food  that  is  too  hot  or  too  cold,  or  be- 
cause of  defective  mastication,  depressing  conditions,  etc.,  yet  dys- 
pepsia may  not  be  a  well-defined  disease. 

Many  so-called  diseases  are  really  states  of  ill  health  often  with- 
out ascertainable  cause.  The  tendency  nowadays  is  to  classify  dis- 
eases according  to  their  causes.  The  highly  artificial  classifications 
of,  say,  a  hundred  years  ago  have  practically  disappeared. 

The  classification  of  diseases  a  hundred  years  ago,  at  the  time  when 
our  State  was  first  being  settled,  was  by  classes,  orders,  genera  and 
species,  just  as  in  the  case  of  botany  and  zoology.  Many  systems  of  class- 
ification have  appeared,  each  one  supposed  to  be  an  improvement  over  pre- 
ceding ones,  and  physicians  are  just  now  working  upon  a  new  system 
which  they  believe  will  stand  the  test  of  time.  Old  systems  were  based  on 
symptoms,  the  new  is  based  on  the  recognition  of  the  cause  of  the  dis- 
ease. Thus  Osier's  recent  treatise  takes  up  first  the  diseases  due  to  ani- 
mal parasites — those  due,  in  order,  to  protozoa,  parasitic  infusoria,  to 
flukes,  cestodes,  uematodes,  and  so  on — followed  by  the  specific  infectious 
diseases,  from  typhoid  and  typhus  fever  running  down  to  tuberculosis  and 
leprosy,  including  some  whose  causes  have  not  been  definitely  identified, 
analogy  admitting  their  inclusion.  The  reactions  or  intoxications  due  to 
the  ingestion  of  chemical  substances,  such  as  alcohol,  morphia  and  lead. 


56  DUSTY    AIK    AND    ILL    HEALTH. 

follow,  with  i  mention  of  sunstroke — and  then  all  at  once  there  is  a  classi- 
fication riot.  For  want  of  something  better,  a  number  of  diesases  are  de- 
scribed under  the  head  of  •Constitutional  Diseases.'  Then  follow  a  host 
of  affections  and  diseases  that  for  convenience  are  grouped  under  their 
respective  organs,  beginning  with  the  diseases  of  the  mouth  and  running 
down  the  alimentary  tract,  followed  by  the  affections  of  the  other  organic 
systems — the  respiratory,  the  nervous,  etc.  One-third  of  the  book  is  thus 
definite,  based  on  a  scientific  system,  the  rest  is  simply  based  on  conven- 
ience of  reference.  Although  we  have  here  real  progress,  yet  how  much 
still  remains  to  be  done."1 

Many  of  the  common  every  day  symptoms  such  as  pain,  head- 
ache, lack  of  appetite,  cough,  insomnia,  constipation,  may  occur 
under  a  variety  of  conditions,  as  for  instance  a  ride  on  a  train  or  a 
visit  to  the  theater.  Those  who  have  traced  the  relationship  often 
prevent  symptoms  by  avoiding  the  cause.  Many  have  learned  the 
lesson  that  prevention  is  easier  than  cure. 

Some  disturbances  of  the  body  are  known  as  "occupational 
diseases;"  there  is  a  large  number  of  them  among  men  confined 
indoors,  especially  when  employed  in  factories  and  exposed  to 
various  sorts  of  irritating  dusts.  We  need  only  think  of  "knife 
grinder's  rot,"  where  the  lungs  are  worn  away  on  account  of  in- 
halation of  gritty  matter,  usually  followed  or  complicated  by  the 
entrance  of  micro-organisms  that  hasten  the  breaking-down  process. 
"Industrial  diseases  are  mostly  dusty  diseases." 

Disease  and  ill  health  go  largely  with  kinds  of  people  and  kinds 
of  occupation.  Some  people  are  readily  killed  off  by  certain  occu- 
pational or  indoor  diseases,  while  others  are  quite  resistent.  The 
Indian,  for  instance,  who  has  always  led  an  active  out-of-door 
life  is  quickly  killed  off  by  so-called  city  or  house  diseases  to  which 
the  Jews  are  quite  resistent ;  the  latter  have  long  been  exposed  to 
them ;  the  susceptible  were  weeded  out  for  generations.  Some  oc- 
cupations are  highly  injurious  to  life;  those  who  follow  them  are 
short-lived,  a  fact  considered  by  insurance  companies  in  their  mor- 
tality tables.  Other  occupations  "take  it  out"  of  the  men,  dis- 
abling them  so  that  when  they  reach  the  age  of  about  forty  years 
they  are  worn  out.  (A  big  industrial  city  has  little  use  for  men 
over  forty.)     A  man's  mode  of  life  and  habits  are  important  fac- 

1  The  Evolution  of  Medicine  in  Indiana.     Proc.  Ind.  Acad.  Science,  1906. 


LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.  57 

tors.  The  place  of  residence  is  important,  whether  in  the  heart  of 
the  city  or  in  the  suhurbs,  or  in  the  country.  In  general  it  may  be 
said  that  city  life  is  very  deteriorating  and  leads  to  "race  suicide." 
A  new  born  child  must  run  the  gauntlet  of  all  kinds  of  diseases. 
Out  of  the  many  born  comparatively  few  reach  old  age.  In  pro- 
portion as  people  live  under  simple  conditions,  in  isolation,  a  larger 
number  is  apt  to  reach  maturity  and  old  age.  Until  recently  san- 
itary conditions  in  large  cities  were  so  bad  that  cities  were  wholly 
unable  to  maintain  themselves;  they  required  the  constant  influx 
of  new  country  blood. 

Studying  Diseases  and  III  Health.  We  all  know  that  med- 
ical men  are  especially  interested  in  diseases  but  some  individuals 
in  ill  health  have  discovered  that  many  doctors  are  not  interested 
in  ill  health,  as  distinct  from  actual  disease.  Some  physieians  will 
discuss  diseases  with  patients  but  have  little  to  say  about  common 
ill  health.  x\s  Moliere  long  ago  observed,  they  want  cases  of  severe 
diseases.  As  a  rule  their  medical  society  discussions  and  articles 
in  medical  journals  relate  to  diseases  rather  than  to  ill  health. 

Because  of  the  fact  that  physicians  do  not  discuss  common  ill 
health  many  communities  are  very  backward  in  the  matter  of  san- 
itation. A  family  physician  may  fully  advise  his  patient  and  his 
family  and  yet  not  have  a  single  word  to  say  to  the  community  as 
a  whole.  Indeed,  there  are  not  lacking  doctors  who  merely  sell 
medicine  in  competition  with  the  druggist;  they  never  give  any 
general  advice  regarding  the  care  of  the  sick  and  the  prevention  of 
ill  health  and  disease.  A  common  explanation  is  that  "we  are  not 
paid  for  it, ' '  and  some  do  little  or  nothing  unless  paid.  Then  there 
are  not  lacking  physicians  who  are  so  ultra-scientific  that  their 
whole  attention  is  given  to  the  patient's  disease  in  contrast  to  the 
faithful  family  physician  who  looks  after  his  patient  and  helps 
him  to  throw  off  the  disease. 

The  following  table1  ma}''  give  some  general  idea  of  the  evolu- 
tion of  the  common  medical  man  of  today,  showing  how  there  has 
been  a  successive  branching  off.     (Read  from  below  up.) 

1  The  Evolution  of  Medicine  in  Indiana.    Presidential  address  Indiana  Academy  of  Science,  1906 


58 


DUSTY    AIR    AND   ILL    HEALTH. 


<P 


V 


J? 


4f 


-4  &s 


0V  </  a*     ^> 


pP*  S.  v       <K 


£>> 


N°VV 


-Specialization    in    Medicine — eye,     throat,    stomach, 
nerves,  etc. 

-Separation  of  the  Surgeon  (Barber's  pole  a  survival  of 
early  times.) 

5  0  2 

«>  o  a> 
so  Pin 

«■  M<  _ 

moo 


I — Separation  of  Sanitarian. 
[ — Separation  of  Bacteriologist. 

-Separation  of  Physiologist. 

-Separation  of  Anatomist. 


-Differentiation  of  Alchemist,  developing  into  the  Chem- 
ist. 

I — Dif.  of  Herbalist,  from  whom  developed  the  Pharmacist 
and  Botanist. 

— Dif.  of  the  Astrologer,  ultimately   developing   into  the 
Astronomer. 

| — Dif.  of  Chief  (survival  of  belief  in  the  King's  Touch  for 
scrofula,  and  of  the  belief  in  the  Divine  Right  of 
Kings.) 

I — Dif.  of  the  Priest.  (Survival  of  Faith  Cures  and  the  power 
of  prayer  in  arresting  epidemics.) 

Differentiation  of  the  Primitive  Medicine  Man.  (Survival 
today  of  primitive  beliefs,  in  charms,  amnlets  incanta- 
tion, nauseous  drugs,  etc. ) 


All  men  alike. 


LOCAL  CONDITIONS  AND  CHANGES  IN  TIME.  59 

The  Indian  ''medicine  man"  needs  scarcely  be  mentioned  be- 
cause he  was  an  ignoramus  of  the  first  water.  The  white  man  has 
nothing  to  learn  from  him. 

The  first  white  medical  men  in  Indiana  were  United  States  army 
surgeons  who  accompanied  the  soldiers  to  treat  the  wounds  in- 
flicted in  battle  rather  than  those  inflicted  by  nature.  They  left 
practically  no  records  of  conditions  found.  Gradually  venture- 
some doctors  from  older  communities  came  to  the  new  settlements 
to  treat  the  wounds  and  injuries  and  the  simple  ailments  of  the 
people,  in  time  getting  more  and  more  to  do  as  the  old  "diseases 
of  civilization"  came  in.  The  first  doctors  were  largely  of  the 
rough  and  ready  kind;  they  used  heroic  measures  and  remedies; 
they  bled  and  purged  and  vomited  and  resorted  freely  to  the  use 
of  mercury.  They  were  abhored  by  women  and  children  and  so 
it  was  not  long  before  physicians  of  a  different  type  gained  a  foot- 
hold, men  who  were  opposed  to  bleeding  and  purging.  Some  of  the 
old  time  diseases  may  have  demanded  heroic  treatment  but  as  a 
rule  ill  health  (in  the  absence  of  well-defined  disease)  demands 
gentle  measures,  and  often  attention  to  a  variety  of  little  things 
rather  than  a  lot  of  strong  medicine. 

In  looking  over  the  old  Transactions  of  the  Indiana  State  Med- 
ical Society  one  finds  that  some  physicians  believed  there  was  a 
change  going  on  in  diseases,  that  not  only  were  new  ones  coming 
in  but  old  ones  were  undergoing  a  modification  and  required  a 
different  mode  of  treatment. 

In  the  course  of  time  medical  schools  were  established.  These 
at  first  had  low  standards;  the  students  came  mainly  direct  from 
the  farm ;  high  schools  were  unknown.  Today  Indiana  has  a  com- 
paratively high  standard  and  instead  of  a  number  of  small  poorly 
equipped  schools  there  is  one  good  one.  It  may  be  said  this  is  due 
to  the  activity  of  physicians  themselves — often  the  people  antag- 
onize higher  standards,  being  satisfied  with  cheap  poorly  qualified 
doctors,  not  real  physicians. 

Medical  instruction  at  first  was  purely  by  lectures,  the  same 
lectures  being  repeated  from  year  to  year.  Listening  to  them  for 
two  years  was  about  the  only  requirement.    In  the  course  of  time 


60  DUSTY    AIR    AND   ILL    HEALTH. 

laboratories  came.  The  students  handle  things  and  experiment. 
But  there  is  danger  of  neglecting  ordinary  observations,  especially 
by  neglecting  a  study  of  people  who  have  ill  health  rather  than 
well-defined  disease.  There  are  no  instruments  for  estimating 
pains  and  aches. 

In  time  also  specialists  arose.  At  first  there  was  a  separation 
into  physicians  and  surgeons.  The  surgeons  sub-divided  into  dif- 
ferent specialities,  as  eye  and  ear,  nose  and  throat,  etc.  Physi- 
cians also  divided  into  specialists,  taking  up  the  internal  organs  of 
the  body.  In  the  course  of  time  general  sanitation  was  given  at- 
tention. The  State  was  prevailed  upon  by  progressive  physicians 
to  look  after  the  community  as  a  whole  through  a  State  Board  of 
Health,  followed  by  county  health  boards  and  this  in  turn  by  city 
boards  of  health.  Unfortunately  all  of  this  work  is  still  quite  ele- 
mentary. As  a  people  we  have  not  yet  reached  a  stage  where  we 
fully  appreciate  disease  prevention.  Only  recently  an  effort  was 
made  at  Washington  to  organize  a  National  Department  of  Health, 
co-ordinating  all  the  various  agencies  in  the  interest  of  the  people, 
just  as  the  Agricultural  Department,  for  instance,  works  in  the 
interest  of  the  farmer  in  giving  him  information  about  his  animals 
and  plants.  But  there  is  always  bitter  opposition  to  medical  men 
and  their  aims  and  methods.  When  we  study  the  question  of 
chronic  ill  health  we  may  find  that  many  are  opposed  to  physicians 
on  account  of  their  failure  to  "cure"  common  ill  health,  especially 
by  the  use  of  drugs.  Much  of  the  common  everyday  ill  health  is 
incurable  but  preventable,  as  I  shall  attempt  to  show  later. 

The  term  "doctor"  originally  meant  a  teacher;  it  still  means 
that  when  applied  to  the  college  professor,  but  it  has  degenerated 
and  from  it  we  have  the  verb  "to  doctor."  Many  of  the  sick  keep 
themselves  poor  by  "doctoring,"  never  getting  the  best  that  the 
art  or  science  of  medicine  has  to  offer.  Just  as  bad  money  drives 
out  good  money,  so  bad  or  poor  doctors  drive  out  good  ones.  When 
the  people  demand  better  doctors  than  they  now  have  they  will  get 
them. 

As  already  mentioned,  there  are  all  sorts  of  causes  that  derange 
health  and  bring  on  ill  health,  as  there  are  all  kinds  of  causes  for 


LOCAL  CONDITIONS  AND  CHANQES  IN  TIME.  61 

accidents  and  fatalities.  Many  causes  are  avoidable  and  ill  health 
and  disease  and  accidents  preventable.  People  living  under  good 
surroundings  and  leading  "healthful"  lives  as  a  rule  have  little 
sickness.  But  in  proportion  as  people  live  under  or  come  in  con- 
tact with  unsanitary  conditions,  or  are  careless,  they  may  suffer. 

What  the  people  expected  from  the  old  time  doctor  was  mainly 
a  lot  of  medicine.  Many  moreover  had  a  belief  that  the  nastier 
medicine  was  the  more  powerful  it  was  apt  to  be.  Intelligent 
people  are  gradually  getting  further  away  from  that  idea;  they 
want  less  and  less  medicine  and  more  and  more  advice.  Physicians 
themselves  have  long  realized  that  many  ills  are  incurable  by  drugs 
but  that  symptoms  can  be  modified  or  palliated.  But  there  are 
still  too  many  people  who  want  only  palliation,  who  only  come  to 
the  doctor  when  feeling  bad;  the  moment  they  feel  better  they 
cease  to  report.  Many  give  him  no  opportunity  at  all  to  "super- 
vise health"  and  reduce  their  ill  health  to  a  minimum. 

Today  we  frequently  hear  the  terms  Health  Inspection,  Med- 
ical Inspection  and  Health  Supervision.  These  terms  are  especially 
used  in  connection  with  school  children.  The  people  are  gradually 
beginning  to  realize  that  there  is  more  in  the  practice  of  medicine 
than  the  simple  giving  of  drugs. 


62 


DUSTY   AIR    AND   ILL    HEALTH. 


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III. 

DUST  AND  DUST  VICTIMS. 


There  are  numerous  kinds  of  dust.  We  can  classify  them  un- 
der two  heads:  Dust  found  in  nature  independent  of  man,  and 
dust  due  to  human  activity.  The  divisions  of  course  overlap,  as 
dust  coming  from  a  field  which  originally  was  a  forest.  One  can 
easily  see  how  in  the  absence  of  man  there  would  be  no  such  dust 
and  yet  at  present  we  speak  of  this  as  dust  independent  of  man. 
The  table1  opposite  in  a  general  way  classifies  dusts  in  the  order 
of  their  probable  appearance  during  the  different  stages  of  man's 
development. 

Dust  due  to  human  activity  may  in  a  general  way  be  divided 
into  Country  Dust  and  City  Dust.  The  kinds  to  be  found  in  the 
country  are  few  in  number  although  making  up  in  volume.  In 
large  cities  there  are  almost  innumerable  kinds,  especially  in  dusty 
occupations.  It  would  be  an  almost  endless  task  to  attempt  to 
describe  occupational  dusts  and  their  deleterious  influence  on  hu- 
man welfare,  but  if  we  narrow  our  inquiry  down  to  say  nine-tenths 
of  the  people  and  to  nine-tenths  of  the  prevalent  kinds  of  dust  we 
can  better  arrive  at  some  general  conclusions. 

Country  Road  Dust.  This  is  the  commonest  form  of  dust.  It 
consists  almost  exclusively  of  pulverized  mineral  matter.  People 
who  live  in  cities  with  well-paved  streets  or  in  countries  with  well- 
kept  roads  have  no  idea  of  dust  conditions  that  at  times  prevail 
in  backward  communities.  Many  of  our  roads  and  so-called  city 
streets  are  covered  with  from  two  to  three  inches  of  dust  (accord- 
ing to  some  of  our  local  newspapers  even  to  a  depth  of  half  a  foot, 
but  this  is  clearly  an  exaggeration).  This  dust  is  more  or  less 
constantly  arising  and  is  carried  about  by  air  currents.  A  strong 
wind  will  fill  the  air  with  a  large  amount  of  fine  particles,  dust 
proper,  while  the  larger  particles  are  forced  along  the  surface  until 
they  come  to  rest,  giving  protection  to  the  finer  particles  under- 

1  Proceedings  Indiana  Academy  of  Science,  Presidential  Address,  1906. 


64  DUSTY   AIR    AND    ILL    HEALTH. 

neath.  With  continued  high  wind  there  will  he  less  and  less  dust 
blown  about  At  times  the  surface  of  some  streets  shows  peculiar 
markings,  ridges,  resembling  those  of  wave  marks  along  a  shore. 
Any  unusual  gust  of  wind  disturbs  this  natural  arrangement  of 
particles;  it  is  of  course  disturbed  by  passing  vehicles,  that  means 
on  streets  that  are  much  travelled  there  are  constant  dust  clouds. 
At  times  a  street  will  be  wind-swept  down  to  the  hard  underlying 
"bed  rock,"  that  is,  to  the  gravel  or  stone  which  has  not  yet  been 
pulverized.  This  condition  is  frequently  seen  on  long,  wide  east 
and  west  streets  where  the  wind  has  free  scope. 

Dust  from  Paved  Streets.  This  varies  in  quantity  and  in 
composition.  In  a  large  city  with  paved  streets  everywhere  and 
with  practically  no  mud  tracked  on  from  unpaved  streets,  dust  is 
composed  chifly  of  horse  droppings  and  coal  dust,  including  under 
this  term  dust  traceable  to  or  derived  from  coal.  In  manufactur- 
ing towns  there  may  be  a  large  amount  of  this  latter.  Then  there 
are  dust  particles  derived  from  the  wear  and  tear  of  the  paving 
material  itself,  besides  various  additions  from  human  beings. 

The  small  city  as  a  rule  has  only  a  few  paved  streets  in  the 
heart  of  the  city  and  "paved  street  dust"  is  mainly  that  brought 
from  the  unpaved  streets,  either  blown  on  by  the  wind  or  more 
commonly  tracked  on  by  vehicles,  that  is,  the  material  adheres  to 
the  hoofs  of  horses  and  wheels  of  wagons  in  the  form  of  mud.  On 
paved  streets  this  dries  out  rapidly  and  becomes  pulverized,  differ- 
ing little  in  composition  from  unpaved  street  dust.  After  a  rain 
unpaved  streets  may  be  "seas  of  mud,"  while  a  nearby  paved 
street  gives  off  a  heavy  dust-cloud. 

Glass  Dust.  One  very  important  ingredient  in  town  dust  is 
pulverized  glass.  The  amount  of  glass  thrown  on  to  streets  which 
ultimately  becomes  pulverized,  and  of  course  blown  about,  is  really 
remarkable.  It  seems  strange  that  such  conditions  should  be  al- 
lowed to  exist — but  what  is  everybody's  business  is  nobody's  bus- 
iness. 

Pollen  Dust.  The  amount  of  pollen  in  the  air  during  the 
summer  varies  greatly.     Pollen  is  derived  from  many  plants,  both 


DUST  AND  DUST  VICTIMS.  65 

wild  and  cultivated.  We  need  only  think  of  the  clouds  of  pollen 
dust  near  pine  forests,  of  which  we  have  none  here,  however.  Of 
pollen  dust  due  to  wild  plants  perhaps  the  most  noted  is  that  de- 
rived from  the  Ragweed  (Ambrosia  artemisiaefolia),  which  man- 
ifests its  presence  in  those  susceptible  as  "Autumnal  Catarrh," 
commonly  known  as  Hay-fever.  There  are  of  course  many  differ- 
ent kinds  of  pollen;  some  individuals  react  to  one  kind,  some  to 
another.    "Rose  Cold"  is  ascribed  to  the  pollen  from  roses. 

Spit  Dust.  This  is  the  most  important  kind  of  dust  from  the 
standpoint  of  the  sanitarian.  It  varies  in  different  cities  and  in 
parts  of  the  same  city.  European  cities  as  a  rule  are  remarkably 
free  from  it,  while  in  our  country  where  the  tobacco  chewing  habit 
prevails  it  is  very  common.  In  large  cities  it  is  apt  to  occur  most 
plentifully  in  neglected  sections,  especially  in  slums,  while  in  the 
smaller  communities  it  is  mainly  found  in  the  heart  of  the  city 
where  street  loafers  meet. 

The  amount  of  tobacco  spittle  on  sidewalks  of  smaller  commu- 
nities is  really  remarkable.  The  photographic  reproductions  in 
the  Appendix  will  perhaps  give  some  idea  to  those  unacquainted 
with  small  city  conditions.  The  student  of  dust  influences  natur- 
ally goes  to  a  community  where  the  kind  of  dust  he  proposes  to 
study  is  most  abundant,  just  as  the  hay-fever  student  goes  to  a 
country  where  hay-fever  or  its  particular  pollen  dust  is  found. 
The  effects  of  coal  dust  and  soot  and  smoke  are  best  studied  in  a 
smoky  city.  The  effects  of  spit  dust  are  best  studied  in  a  com- 
munity where  the  spitting  habit  prevails,  not  only  sidewalk  spit- 
ting but  also  floor  spitting.  Spittle  is  tracked  about,  it  dries  and 
becomes  pulverized  and  fills  the  air.  Spit  dust  is  common  not  only 
on  down  town  streets  but  also  in  stores  and  offices.  It  is  carried 
home  on  shoes  and  dresses.  Country  women  with  trailing  dresses 
may  carry  a  large  amount  to  their  homes.  The  term  spit  dust  is 
not  an  elegant  one;  it  grates  on  the  ears  when  heard  repeatedly, 
therefore  in  this  volume  the  simple  term  dust  should  be  understood 
as  applying  to  spit  dust.  The  terms  bad  air,  crowd  poison,  and 
similar  references  in  this  volume  should  also  be  understood  as 
synonyms. 

15] 


66  DUSTY   AIR   AND   ILL  HEALTIT. 

Smoke  and  Smog.  Some  cities  and  towns  are  smoky  rather 
than  dusty,  especially  manufacturing  communities  where  no  atten- 
tion is  given  to  smoke  prevention.  A  smoky  city  is  naturally  more 
or  less  dusty  because  no  special  efforts  at  cleanliness  are  made. 
Recently  the  term  smog  came  into  use,  signifying  the  smoke,  dust, 
and  fog  cloud  which  overhangs  cities.  There  are  all  sorts  of  opin- 
ions regarding  the  injuriousness  of  smoke.  It  is  well  known  that 
carbon  particles  are  deposited  in  the  lungs.  The  lungs  of  old  city 
residents  may  be  coal  black,  yet  some  of  these  people  live  on  to 
old  age ;  they  are  exceptional  of  course.  That  the  effects  of  smoke 
on  comfort,  on  clothing  and  on  furniture,  and  on  health  are  more 
or  less  marked  must  be  self-evident.  The  air  of  a  smoky  city  may 
be  so  bad  that  trees  can  not  thrive  in  it — but  human  beings  are 
expected  to  thrive.  Since  this  volume  is  a  study  of  the  influence 
of  dust,  the  subject  of  smoke  must  be  dismissed  with  this  brief 
mention. 

Indoor  Dust.  Many  people  when  they  hear  the  word  dust 
think  of  the  dust  clouds  blowing  about  out  of  doors ;  the  physician 
thinks  mainly  of  indoor  dust.  This  latter  of  course  varies  greatly, 
depending  on  the  nature  of  the  building,  whether  a  home,  store, 
factory,  school  house,  church  or  theater,  etc.  It  will  also  vary  ac- 
cording to  the  kind  of  people  who  occupy  such  structures,  whether 
or  not  they  are  cleanly  in  their  habits.  Thus  a  five  cent  theater 
may  have  a  very  filthy  floor,  giving  off  a  virulent  dust,  while  a  fine 
opera  house  patronized  by  clean  people  only  may  be  relatively 
clean.  The  location  of  a  house  may  be  very  important.  To  realize 
this  one  need  only  look  at  a  down  town  stairway  leading  from  the 
sidewalk  to  the  upper  floors ;  some  have  a  mass  of  filth  all  the  way 
up,  with  much  dust  blowing  up  into  the  rooms.  In  the  suburbs  a 
stairways  may  be  clean.  Some  buildings  have  special  forms  of  dust ; 
we  need  only  think  of  school  houses  and  chalk  dust,  to  which  some 
individuals  are  susceptible. 

There  are  all  kinds  of  indoor  dusts  to  which  special  names  may 
be  applied.  To  some  bookdust  or  library  dust  is  important.  It 
will  readily  be  seen  that  this  is  mainly  an  accumulation  of  dust 
that  has  been  in  the  air  and  has  settled  down  on  the  books,  espe- 


DUST  AND  DUST  VICTIMS.  67 

cially  on  those  with  rough  edges.  However  one  must  not  forget 
that  infective  material  may  be  deposited  between  the  leaves  by 
coughing  or  sneezing,  as  well  as  by  soiled  fingers.  Whether  a  li- 
brary is  in  the  heart  of  a  dirty  city  or  in  a  clean  suburb  inhabited 
by  cleanly  people  may  make  a  marked  difference  to  the  reader  who 
is  a  dust  victim. 

Dust  of  Dwellings.  In  a  general  way  this  can  be  divided 
into  several  varieties,  the  most  common  being  Floor  Dust.  The 
amount  varies  greatly  in  different  homes  and  is  dependent  on  a 
number  of  factors,  especially  on  proximity  to  dust  sources  and  on 
the  nature  of  the  floor  covering,  being  least  with  waxed  floors  and 
greatest  with  a  carpet  that  is  tacked  down  and  very  seldom  cleaned. 
(I  have  known  carpets  that  have  been  down  for  several  years;  any 
one  walking  over  them  would  stir  up  a  cloud  of  dust,  clearly  vis- 
ible in  a  beam  of  sunlight.)  One  can  readily  understand  how 
people  living  in  rooms  heavily  carpeted  may  be  constantly  inhaling 
dust  and  why  there  should  be  complaint  of  symptoms  of  ill  health. 
At  times  people  will  complain  of  windstorms  bringing  on  certain 
symptoms  or  an  attack  of  ill  health.  Further  on  I  mention  a 
patient  who  thus  complained.  The  cause  was  floor  dust,  blown  out 
of  crevices  and  carpets.  Another  dust  that  should  be  mentioned 
is  that  derived  from  hot  air  furnaces,  especially  from  old  leaky 
ones.  The  question,  What  is  the  best  method  of  heating  a  house? 
is  not  at  all  a  simple  one. 

The  different  sources  of  house  dust  need  not  be  enumerated. 
I  recall  the  home  of  a  patient  where  the  wall  paper  contained 
glistening  mineral  matter,  which  was  constantly  falling  off  in  the 
form  of  a  very  irritating  dust,  this  being  most  marked  on  windy 
days  when  the  accumulated  matter  would  be  blown  out  of  the 
cracks  in  the  floor  and  fill  the  room. 

In  households  where  featherbeds  are  still  used  the  bedrooms 
may  be  filled  with  an  irritating  "feather-bed  dust"  to  which  some 
react.1 


1  Feather  bed  dust  is  one  of  the  few  kinds  of  dust  to  which  I  react,  as  I  discovered  on  sleeping  in 
an  old  feather  bed  in  an  isolated  mountain  inn  among  the  Alps.  This  dust  seti  up  a  profuse  mucus 
flow.  The  experience  seemed  so  odd  that  I  made  a  note  for  a  medical  journal  (Indiana  Medical  Journal 
January,  1901). 


68  DUSTY    AIR    AND   ILL   HEALTH. 

Sterilized  and  Unsterilized  Dust.  Dust  containing  dried 
spittle  may  contain  all  sorts  of  infectious  matter,  especially  that 
derived  from  people  in  ill  health  or  diseased,  those  having  colds 
and  catarrh,  bronchitis,  etc.,  including  pneumonia,  and  tubercu- 
losis. But  such  infectious  matter  becomes  sterile,  harmless,  in  the 
course  of  time,  both  under  the  influence  of  age  and  of  bright  sun- 
light, Strong  sunlight  quickly  destroys  microbic  life.  Protected 
from  sunlight,  as  in  a  closed  room,  infected  dust  may  retain  its 
virulency  for  a  long  time,  for  months. 

Popularly  it  is  believed  that  the  air  of  the  country  home  is 
good;  as  a  matter  of  fact  often  it  is  worse  than  that  of  the  city 
home.  Country  women  will  trail  their  dresses  over  filthy  sidewalks 
and  then  clean  them  in  the  living  room,  filling  the  house  with  in- 
fection. Many  city  homes  have  waxed  floors  and  rugs  that  are 
taken  out  and  cleaned  frequently,  but  country  homes  as  a  rule 
have  a  carpet  that  is  taken  up  only  at  long  intervals,  perhaps  not 
even  once  a  year.  The  mode  of  heating  a  house  must  also  be  con- 
sidered, whether  there  is  constant  ingress  of  outdoor  air. 

A  farmer  who  sees  clouds  of  dust  blowing  off  a  road  or  from  the 
fields  (in  harrowing  a  field  great  clouds  may  be  given  off)  may  not 
realize  that  dust  from  a  filthy  city  or  from  an  old  carpet  is  some- 
thing entirely  different,  a  something  to  be  avoided. 

In  studying  dust  influences  one  must  not  only  consider  the 
place  of  residence,  the  kind  of  home,  but  also  habits  of  general 
cleanliness.  As  a  matter  of  fact,  the  study  of  dust  influences  is  a 
study  of  endless  details,  as  case  reports  cited  later  on  may  show. 

"Beneficent  Dust."  Several  years  ago  a  short  article  under 
this  caption  made  the  rounds  of  the  newspapers.  Several  of  my 
a-b-c  patients  gave  me  copies,  thinking  that  the  article  was  antag- 
onistic to  my  own  ideas  regarding  the  injuriousness  of  dust.  That 
article  was  evidently  written  by  a  physicist  and  the  kind  of  dust 
he  had  in  mind  was  more  particularly  the  cosmic  dust  that  floats 
high  in  the  atmosphere,  modifying  light  and  moisture.  My  "old 
experienced  patients"  readily  saw  that  the  article  and  the  kind  of 
dust  had  nothing  whatever  to  do  with  the  very  practical  aspects 


DUST  AND  DUST  VICTIMS.  69 

of  the  dust  problem  as  seen  in  every-day  life,  the  battle  of  the 
housewife  against  dust  and  of  communities  warring  against  dirt 
and  dust. 

SPITTING  OR  EXPECTORATION. 

We  must  distinguish  between  two  kinds  of  spitting,  one  neces- 
sary, the  other  needless.  Spitting  tobacco  juice  is  wholly  senseless. 
It  seems  strange  that  men  should  fill  the  mouth  with  a  poisonous 
weed  and  then  begin  to  work  the  jaws  and  secrete  a  lot  of  fluid 
which,  discolored  by  tobacco,  is  spit  out  promiscuously.  That 
many  of  these  spitters  have  catarrh  and  bronchitis  and  tonsillitis 
and  consumption  must  be  self-evident.  Moreover  the  tobacco  user 
encourages  others  to  spit.  In  European  countries  where  the  chew- 
ing of  tobacco  is  unknown  one  sees  little  spittle  on  the  sidewalks. 
One  of  the  first  things  Dickens  noticed  on  coming  to  our  country 
was  the  American  spitting  habit.  He  also  wrote  of  American 
catarrh,  but  he  evidently  did  not  see  the  relationship.  When 
spittle  is  pulverized,  it  arises  as  dust  and  is  inhaled  by  others,  the 
germs  in  it  ready  to  set  up  disturbances.  As  the  seed  of  weeds  go 
from  one  field  to  another,  so  the  germs  of  diseases  go  from  one 
individual  to  another. 

The  practice  of  spitting  upon  or  at  a  person  to  show  utter  con- 
tempt has  practically  disappeared.  It  is  to  be  hoped  that  the 
practice  of  chewing  tobacco  and  soiling  floors  and  sidewalks  will 
also  disappear.  Some  even  advocate  anti-smoking  laws  because 
the  smoker  (men,  women  seldom  smoke)  spits  more  or  less. 

The  other  kind  of  spitting,  perhaps  it  should  be  called  expec- 
toration, is  a  normal  or  physiological  process,  especially  common 
among  people  living  under  dusty  air  conditions.  Dust  inhaled 
lodges  on  the  mucous  membranes,  all  the  way  from  the  nose  down 
into  the  lungs  (a  small  quantity  may  lodge  in  the  lungs  and  be  im- 
bedded in  the  tissues  and  the  lungs  in  time  become  black;  the 
lungs  of  people  of  smoky  and  dusty  cities  are  usually  coal  black) . 
Mucous  membranes  contain  glands  which  give  off  mucus  which 
forms  a  coating,  protecting  them.  But  a  more  important  function 
of  mucus  is  to  entangle  dust.     The  city  man  when  he  blows  his 


70  DUSTY    AIR    AND    ILL    HEALTH. 

nose  "blows  black."  When  sufficient  mucus  has  accumulated  in 
the  throat  it  can  be  hawked  up.  Students  of  bird  lore  know  how 
the  owl  ejects  pellets;  it  swallows  mice  and  absorbs  the  nutriment 
and  then  the  bones  are  wrapped  in  the  skin  and  cast  out.  A  sim- 
ilar process  occurs  when  dusty  air  is  inhaled,  we  "spit  black." 
One  need  scarcely  refer  to  the  fact  that  the  body  absorbs  the  life- 
giving  oxygen  from  the  air  and  emits  carbonic  acid  gas,  the  latter 
a  union  of  the  oxygen  inhaled  with  the  carbon  ingested  as  food, 
the  result  of  the  decomposition  being  heat  and  force. 

But  we  should  clearly  distinguish  between  these  two  kinds  of 
spitting,  more  properly  speaking  between  spitting  and  expectora- 
tion, the  one  is  useless  and  unnecessary,  the  other  a  normal  process 
that  should  be  encouraged. 

During  the  last  few  years  there  has  been  a  general  command, 
Do  Not  Spit.  This  has  led  many  to  retain  what  nature  intended 
should  be  spewed  out.  Children  are  often  reproved  for  expecto- 
rating when  in  fact  they  should  be  encouraged.  But  where  should 
abnormal  secretions  be  deposited  ?  Spittle,  or  expectoration,  should 
be  deposited  where  it  does  not  become  pulverized  and  fill  the  air! 
This  is  particularly  necessary  in  the  case  of  those  afflicted  with 
disease.  Some  persons  think  they  are  cleanly  when  they  expec- 
torate into  a  handkerchief,  but  if  we  observe  how  some  shake  their 
handkerchiefs  in  the  air,  especially  in  closed  rooms,  we  will  come 
to  the  conclusion  that  that  is  not  at  all  a  sanitary  practice.  The 
Chautauqua  salute  for  this  reason  is  now  recognized  as  objection- 
able. 

Railway  passengers  are  often  compelled  to  inhale  much  smoke 
and  dust ;  this  is  followed  by  a  free  formation  of  mucus.  What 
shall  be  done  with  this?  Some  railroad  companies  furnish  cuspi- 
dors; others  have  conspicuous  signs,  Do  Not  Spit,  leaving  the  pas- 
senger at  a.  loss  what  to  do.  He  will  either  spit  into  his  handker- 
chief, out  of  the  window,  or  stealthily  on  the  floor,  or  perhaps  swal- 
low what  nature  intended  should  be  spat  out.  Riding  on  cleanly 
trolley  cars  is  less  apt  to  be  followed  by  a  mucus  flow.  Although 
the  average  trolley  car  may  show  less  dust  than  the  average  day 
coach,  yet  the  dust  may  be  more  objectionable  because  containing 


DUST  AND  DUST  VICTIMS.  7] 

more  infection  from  spitters;  spitters  are  more  apt  to  patronize 
trolleys. 

What  about  sidewalk  spitting?  Some  European  cities  have  a 
small  stream  of  water  flowing  along  the  gutter. 

The  solution  of  the  anti-spitting  question  may  seem  complex ; 
in  reality  it  is  simple.  People  who  inhale  clean  air  have  no  abnor- 
mal respiratory  secretions,  they  have  no  need  to  spit  at  all !  The 
remedy  is  to  clean  up !  When  our  cities  give  their  people  clean 
air  as  they  now  attempt  to  give  them  clean  water  the  necessity  for 
expectorating  will  disappear.  And  as  to  the  tobacco  chewer,  he 
should  be  sternly  repressed.  He  is  an  anomaly  under  present-day 
civilization,  and  no  doubt  the  smoker  also  will  become  an  anomaly 
before  long. 

Sometimes  people  question,  Is  dust  after  all  injurious?  We 
might  refer  them  to  the  watch  maker  or  the  automobilist ;  they 
have  some  decided  opinions !  Why  should  dust  be  less  injurious 
to  the  human  machinery? 

Every  housewife  knows  that  a  small  particle  of  infection  in 
her  canned  fruit  produces  a  certain  effect.  A  large  amount  of 
common  dust  may  choke  up  a  man  but  a  smaller  quantity  of  in- 
fected dust  may  produce  effects  not  so  quickly  apparent,  although 
perhaps  much  more  serious,  as  I  shall  attempt  to  show  in  Case 
Reports. 

Some  ask.  What  becomes  of  the  dust  that  is  inhaled,  how  does 
it  affect  the  body?  How  does  it  affect  the  organs?  How  does  it 
affect  states  of  the  body  designated  as  health  and  ill  health  and 
disease  ?  Some  people  are  constantly  hawking  and  spitting ;  what- 
ever they  inhale  comes  up  entangled  with  mucus;  others  never 
hawk  and  spit ;  all  the  dust  inhaled  seems  to  remain.  I  have  some 
patients  under  observation  who  the  moment  they  cease  to  "spit 
black"  begin  to  complain  but  with  a  return  of  this  expectoration 
feel  better.  Some  may  actually  be  sick  during  this  interval;  ap- 
parently there  is  an  overworking  of  the  defences  of  the  body.  It 
would  seem  that  the  resulting  sickness  is  really  a  conservative 
process  and  that  the  pains  and  aches  are  merely  warnings  that  a 
struggle  is  going  on  in  the  body. 


72  DUSTY    AIR    AND   ILL    HEALTH. 

While  these  notes  were  being  put  together  one  of  ray  old  pa- 
tients, who  has  been  with  me  for  years,  had  undergone  a  siege  of 
"lumbago."  He  is  a  dust  victim  who  complains  hoth  of  "dys- 
pepsia1' and  of  '•  rheumatism."  His  occupation  is  one  that  com- 
pels him  to  inhale  much  coal  smoke;  he  always  "spits  black"  but 
he  does  not  complain  unless  he  also  inhales  infected  dust.  Recently 
he  had  a  disturbed  stomach  and  then  lumbago  developed;  this 
rendered  him  bedfast  or  at  least  "housefast"  for  several  weeks. 
It  was  really  an  enforced  vacation.  He  soon  noticed  that  his  stom- 
ach was  "all  right"  and  that  he  no  longer  spit  black.  On  getting 
back  to  work  he  promptly  began  to  "spit  black"  and  it  will  be 
only  a  question  of  time  until  he  again  complains  of  "dyspepsia." 

This  patient  had  had  all  sorts  of  experience  among  physicians 
before  coming  to  me.  The  last  one  blistered  him  to  such  an  extent 
that  he  had  to  stop  work — he  got  better  however.  He  now  wonders 
whether  the  best  place  for  a  blister  is  not  on  the  soles  of  the  feet ; 
that  will  keep  a  man  at  home  and  give  nature  a  chance,  to  cause 
symptoms  to  disappear,  not  to  speak  of  "bringing  back  health." 

Medical  men  have  names  for  the  effects  produced  by  the  in- 
halation of  different  forms  of  dust:  Anthracosis  for  the  effects 
produced  especially  in  coal  miners ;  Byssinosis  due  to  inhaling  cot- 
ton dust,  as  in  cotton  factories;  Chalicosis,  Silicosis  and  Siderosis 
are  names  applied  to  affections  in  potters,  stonemasons  and  iron- 
workers who  inhale  gritty  matter.  The  term  Pollenosis  is  now  com- 
ing into  general  use ;  the  name  indicates  a  state  or  condition  pro- 
duced by  inhaling  pollen,  that  is  in  those  susceptible.  Lack  of 
space  prevents  entering  into  further  details.  From  now  on  we 
shall  consider  the  effects  of  infected  dust,  Coniosis. 

The  photographs  in  the  Appendix  show  why  infected  dust  is 
common  in  some  communities — communities  where  the  tobacco 
spitting  habit  is  unrestricted.  The  tobacco  chewer  encourages 
others  to  spit,  not  only  on  sidewalks  but  also  on  the  floors  of  build- 
ings and  street  cars. 


DUST   AND  DUST  VICTIMS.  73 


DUST  VICTIMS. 


Individuals  who  react  to  infected  dust  (spit  dust)  may  prop- 
erly be  called  Dust  Victims.  There  is  a  marked  variation  in  sus- 
ceptibility. Some  react  readily,  others  scarcely  at  all.  We  do  not 
know  why  some  individuals  react  to  some  things  or  causes  and  not 
to  others,  why  for  instance  one  may  have  rose  cold  and  another 
bay-fever,  no  more  than  we  know  why  some  people  can  not  eat 
strawberries  or  papaws  or  cheese  without  feeling  bad.  Some  can 
not  drink  soda  water.  Some  teachers  can  not  work  at  the  black- 
board on  account  of  irritating  chalk  dust.  Because  we  do  not  know 
why  they  react,  we  say  the  individual  has  an  idiosyncrasy,  dismiss- 
ing the  explanation  with  a  long  word,  which  after  all  does  not 
explain.  Some  men  on  attempting  to  work  in  certain  factories 
encounter  certain  kinds  of  dust  to  which  they  react;  they  "give 
up  the  job,  just  can't  stand  it."    That  also  is  a  simple  explanation. 

I  have  frequently  talked  with  individuals  who  believed  they 
were  subject  to  crowd  poison,  they  avoided  certain  places.  "Crowd 
Poison"  is  a  vague  abstraction,  it  does  not  enable  a  man  to  guard 
himself.  He  assumes  crowd  poison  to  be  an  entity,  and  yet  he  does 
not  know  where  or  when  it  is  found  nor  how  avoided.  How  many 
individuals  are  required  to  make  a  crowd?  Is  one's  own  family  a 
crowd?  Is  a  man  living  at  home  subject  to  crowd  poison?  Some 
of  these  individuals  became  my  patients  and  in  time  learned  that 
crowd  poison  really  means  Dust  Poison,  that  they  were  Dust  Vic- 
tims. By  learning  whether  infected  dust  is  present  they  can  largely 
avoid  symptoms  of  ill  health.  They  can  go  into  crowds  of  neat  and 
clean  people  where  the  air  is  reasonably  pure,  but  it  is  risky  for 
them  to  go,  for  instance,  to  a  political  meeting  where  men  spit  on 
the  floor.  (Perhaps  this  explains  why  some  men  take  no  interest 
in  ward  politics.) 

Classification  of  Dust  Victims.  In  studying  a  large  number 
of  dust  victims  one  can  divide  them  into  groups,  according  to  how 
they  react  or  how  they  complain,  or  as  a  physician  would  say,  ac- 
cording to  their  syndromes  or  symptom-complexes.    In  other  words, 


74  DUSTY    AIR    AND   ILL    HEALTII. 

there  are  different,  kinds  of  dust  victims.  At  the  one  extreme  the 
reaction  may  be  so  slight  that  one  can  scarcely  speak  of  ill  health 
or  sickness ;  there  may  be  a  mere  sense  of  discomfort,  there  are  not 
even  well-defined  aches  or  pains,  yet  the  individual  recognizes  the 
fact  that  he  is  "not  up  to  standard."  At  the  other  extreme,  at- 
tacks may  be  so  marked  that  the  individual  is  promptly  disabled. 
The  chief  kinds  of  types  of  dust  victims  may  be  classified  about 
as  follows: 

1.  Simple  Dust  Victims  may  complain  of  a  mere  sense  of  dis- 
comfort. There  is  no  localization  in  the  body  unless  it  be  in  the 
respiratory  mucous  membranes,  which  may  be  more  or  less  irritated. 
An  acute  attack  often  manifests  itself  as  a  "cold,"  and  we  know 
that  that  usually  means  an  irritation  of  the  air  passages  accom- 
panied by  cough.  (Cough  is  mainly  a  conservative  process,  it  helps 
to  bring  up  abnormal  secretions  and  inhaled  dust.)  There  is  more 
or  less  secretion  from  the  mucous  membranes,  commonly  called 
catarrh,  varying  from  very  thin  and  watery  to  thick  and  purulent. 
It  is  rather  unfortunate  that  the  term  "Cold"  is  used  but  since 
"everybody  knows  what  a  cold  is,"  even  physicians  continue  to 
use  the  term. 

Colds  are  most  common  during  the  cold  season  because  then 
people  house  themselves  up,  they  live  in  an  "indoor  climate." 
People  who  live  in  the  open  are  no  more  subject  to  colds  in  the 
winter  than  they  are  in  summer.  Often  an  attack  of  dust  infection 
manifests  itself  by  what  may  be  called  a  pre-cold;  "sitting  in  a 
draught."  "getting  the  feet  wet"  may  bring  a  cold  to  the  surface. 
I  know  from  personal  experience  that  colds  can  be  largely  pre- 
vented by  giving  attention  to  air  conditions. 

Perhaps  it  is  needless  to  refer  to  the  well-known  observation 
that  colds  often  "change  to  something  else."  A  deranged  ali- 
mentary tract  is  very  common,  likewise  nervous  symptoms,  notably 
headache  and  restlessness  and  sleeplessness.  That  colds  are  often 
the  foundation  for  fatal  diseases  is  well  known,  embodied  in  the 
old  saying,  "Caught  his  death  o'  cold."  To  the  physician  it  is 
interesting  to  find  out  what  preceded  the  fatal  termination. 


DUST  AND  DUST  VICTIMS.  75 

People  habitually  living  under  bad  air  conditions  are  more  or 
less  annoyed  by  what  is  known  as  catarrh  and  hence  many  people 
have  the  idea  that  catarrh  is  universal,  that  everybody  has  catarrh. 
This  is  not  true.  Dyspepsia  is  also  very  common,  especially  among 
city  people,  some  of  whom  are  constantly  dosing  themselves  with 
dyspepsia  cures.  Yet  when  such  individuals  exchange  air  condi- 
tions and  get  into  good  air  their  so-called  dyspepsia  may  promptly 
leave  them,  to  return  with  a  return  to  bad  air  conditions.  An  at- 
tack of  dust  infection  that  produces  a  "cold"  in  one  may  produce 
an  attack  of  dyspepsia  in  another.  Still  another  may  have  a  head- 
ache, or  an  attack  of  so-called  nervous  prostration. 

2.  Rheumatic  Type.  In  this  type  an  attack  is  manifested  by 
pains  and  aches,  at  times  localized.  In  many  the  pain  regularly 
recurs  at  the  site  of  an  old  injury,  that  is,  every  time  there  is  an 
exposure  to  bad  air  a  certain  part  of  the  body  begins  to  ache.  Dust 
victims  of  this  type  are  often  referred  to  as  being  rheumatic  or 
gouty.  The  latter  term  is  rarely  used  in  this  country,  but  is  very 
common  in  England.  Individuals  who  are  said  to  have  gout  or  to 
be  gouty  are  often  found  to  be  dust  victims ;  a  sedentary  life  and 
overeating  are  factors. 

We  all  have  heard  of  the  old  soldier  who  carries  a  bullet  in  his 
leg  and  who  is  said  to  be  able  to  prognosticate  the  weather;  he 
feels  the  pain  at  the  site  of  an  old  injury.  These  "human  barom- 
eters" are  usually  dust  victims. 

3.  Digestive  Tract  Type.  In  some  individuals  the  alimentary 
tract  rather  than  the  respiratory  reacts,  there  are  all  sorts  of  dis- 
turbances in  the  stomach  and  bowels,  perhaps  also  in  the  liver.  In 
a  general  way  one  can  divide  this  group  into  two  classes,  those  in 
whom  the  reaction  is  mainly  in  the  stomach,  manifested  by  so- 
called  "dyspepsia,"  and  in  the  other  where  the  disturbance  is 
chiefly  in  the  intestines  manifested  mainly  by  constipation.  A 
large  number  of  individuals  however  have  disturbances  throughout 
the  alimentary  tract.  In  some  the  disturbance  begins  in  the  stom- 
ach and  gradually  extends  into  and  through  the  intestines,  with  all 
sorts  of  symptoms  and  with  more  or  less  mucus.    At  times  much 


76  DUSTY    AIR    AND   ILL   HEALTH. 

mucus  is  vomited  and  then  again  mucus  is  passed  off  from  the 
bowels,  often  in  the  form  of  strings  or  ribbons  (membranous 
catarrh  of  the  intestines).  Dust  Victims  of  this  latter  kind  usually 
have  a  train  of  symptoms  referable  to  the  nervous  system  and  hence 
this  class  forms  a  connecting  link  with  the  next  group. 

4.  Nervous  Type.  Europeans  sometimes  speak  of  a  Triad  of 
American  Diseases,  namely,  catarrh,  dyspepsia,  and  nervous  pros- 
tration. Some  dust  victims  manifest  a  train  of  nervous  symptoirs, 
headache  being  the  most  common.  The  names  commonly  applied 
are  nervous  prostration,  neurasthenia,  hysteria,  hypochondria, 
imaginary  illness,  etc.  They  exhibit  no  well  marked  evidences  of 
"disease"  and  because  the  physician  is  unable  to  find  "lesions," 
that  is,  organic  changes,  individuals  are  at  times  referred  to  as  hav- 
ing an  "imaginary  disease."  If  they  get  no  satisfaction  from  reg- 
ular physicians,  they  naturally  apply  to  irregulars  and  quacks  of 
all  kinds  in  their  attempt  to  get  relief.  Often  individuals  present 
the  picture  of  health ;  they  may  complain  very  little — only  to  the 
physician  who  understands  them.  This  form  of  dust  infection 
is  common  among  people  who  use  their  brains  rather  than  their 
hands.  In  illustration  one  may  say  that  a  headache  disables  a 
brain  worker,  while  a  backache  disables  a  manual  laborer. 

5.  Cardio-vascular  Type.  In  this  type  the  reaction  manifests 
itself  mainly  by  disturbances  in  the  blood-vessels  and  heart,  includ- 
ing at  times  the  blood-vessels  of  the  organs,  notably  the  kidneys. 
This  type  is  to  be  especially  looked  for  in  individuals  past  middle 
life;  there  is  a  progressive  development  more  or  less  rapid. 

Dust  victims  as  a  whole  fall  into  two  groups:  (a)  Those  in 
Avhom  there  is  low  blood  pressure  with  a  tendency  to  end  in  such 
wasting  diseases  as  tuberculosis  and  catarrhal  pneumonia;  (b) 
Those  with  a  high  blood  pressure,  tending  to  so-called  heart  and 
kidney  diseases,  perishing  especially  from  apoplexy  or  paralysis  or 
from  Bright 's  disease. 

Classifying  Pateents.  Ill  health  like  disease  is  no  respector  of 
persons,  but  the  ill  health  of  small  children  may  differ  from  that  of 


DUST  AND  DUST  VICTIMS.  77 

old  people,  as  the  ill  health  of  the  man  in  active  life  may  differ 
from  either.     One  can  group  patients  as  follows: 

1.  Small  children  up  to  school  age. 

2.  School  children  up  to  the  time  of  getting  into  some  occupation. 

3.  Occupational  life,  that  lis,  the  active  period  of  a  man's  (or 
woman's)  life. 

4.  The  time  when  a  man  is  "no  longer  wanted,"  that  is  about  the 
time  gray  hair  begin  to  appear.  This  is  the  time  when  the  busy  city  has 
little  use  for  a  man  and  when  employers  are  on  the  lookout  for  a  younger 
man. 

5.  Old  age,  when  a  man  is  no  longer  able  to  work. 

A  physician  can  also  classify  his  patients  according  to  their 
occupation.  But  in  this  case  the  physician's  location  largely  de- 
termines. We  need  only  think  of  the  physician  in  the  agricultural 
community  or  in  a  mining  town  or  in  a  manufacturing  city.  A 
physician  in  the  heart  of  a  large  city  encounters  a  different  class  of 
people  from  one  who  is  located  in  the  suburbs.  The  small  town 
doctor  usually  has  good  opportunity  for  studying  a  variety  of 
people,  including  of  course  farmers. 

All  sorts  of  classifications  are  possible,  including  such  simple 
ones  as  patients  able  to  pay  for  services,  or  not  able  to  pay;  pa- 
tients who  ask  few  questions  but  ready  to  swallow  any  medicine, 
those  who  ask  many  questions,  who  want  to  know  and  who  hesitate 
to  take  a  lot  of  medicine.  The  people  themselves  have  the  doctors 
classified  and  they  have  their  preferences.  They  may  consult  one 
and  wholly  neglect  the  other.  There  are  all  sorts  of  people,  all 
sorts  of  patients,  and  there  are  all  sorts  of  "medicine  men"  to  sup- 
ply wants  and  needs. 

Classifying  the  People.  The  people  of  a  community  can  be 
classified  in  the  light  of  "case  reports"  to  be  given  in  this  volume 
about  as  follows : 

1.  The  Healthy.  Naturally  people  of  this  kind  do  not  come  to  the 
physician.    If  he  wants  to  study  them  he  must  look  them  up. 

2.  Those  in  ill  health  (without  any  well-defined  disease).  Individu- 
als of  this  kind  often  drift  about  among  physicians,  getting  plenty  of 
medicine  and  more  or  less  advice,  but  rarely  any  study  regarding  the 
causes  of  their  ill  health.     This  is  the  kind  of  cases  here  especially  con- 


78  DUSTY   AIB   AND  ILL   HEALTH. 

sidered.     Out  of  this  group  those  who  are  willing  aud  able  to  follow  the 
physician's  advice  are  the  desirables. 

3.  The  diseased,  that  is  those  afflicted  with  a  disease  (well-defined 
disease  or  disease  due  to  a  definite  specific  cause).  We  need  only  think 
of  cases  of  tuberculosis  or  typhoid  fever,  of  cancer,  of  lead  poisoning,  etc. 

4.  The  moribund,  where  the  sand  of  life  has  about  run  down,  with 
death  in  sight,  where  little  is  to  be  expected  from  any  sort  of  treatment. 
There  may  be  so  little  health  left  that  the  student  of  dust  influence  does 
not  want  them  at  all.  (That  an  individual  is  in  a  critical  condition  can 
often  be  discovered  only  upon  thorough  investigation — and  then  it  may 
seem  cruel  to  refuse  services.) 

Patients  or  Fellow  Students.  In  order  to  study  the  subject 
of  Dust  Influences  fully  and  follow  up  developments,  a  physician 
must  have  patients  who  are  willing  to  help,  who  will  observe  how 
they  are  affected  and  report  faithfully.  The  best  patients  of  course 
are  those  who  are  both  willing  and  fully  able  to  live  up  to  the 
physician's  best  advice.  Those  who  can  not  do  this  can  scarcely 
expect  much  from  a  physician.  The  poor  man  who  works  when  he 
should  rest  is  to  be  pitied.  He  requires  more  than  a  "little  medi- 
cine. ' ' 

Missionary  Spirit.  When  an  individual  who  has  had  more  or 
less  ill  health  gets  relief  he  may  manifest  a  desire  or  disposition  to 
help  others.  Some  recommend  "my  doctor;"  others  give  copies 
of  a  prescription  which  helped  them.  Some  recommend  some  nos- 
trum or  patent  medicine  which  seemed  to  have  benefited,  they  even 
write  testimonials.  A  man  cured  by  some  "faith  cure"  may  pub- 
lish an  account  of  it. 

There  is  another  way  in  which  this  disposition  manifests 
itself:  allowing  the  physician  to  use  case  reports.  Physicians  of 
course  constantly  use  case  reports  and  case  histories  without  asking 
permission  or  saying  anything  to  their  patients,  but  such  reports 
are  usually  so  written  that  the  patient  is  not  likely  to  be  identified. 
The  physician  practising  in  a  small  community  however  can  not  do 
as  he  pleases  about  reporting  cases  One  very  potent  reason  why 
the  country  doctor  writes  so  little  for  the  medical  journals  and 
reports  cases  is  that  if  he  characterizes  too  closely  there  is  apt  to 
be  identification  and  as  a  result  perhaps  get  him  into  difficulties. 


DUST  AND  DUST  VICTIMS.  79 

Although  many  people  do  not  object  to  being  talked  about  by  tin: 
doctor,  others  object  seriously.  Some  do  not  want  "a  doctor  who 
talks." 

At  times  a  physician  may  give  service  to  individuals  in  return 
for  data,  that  is  allow  him  to  use  case  reports.  Every  community 
has  poor  people  but  unfortunately  their  lives  are  so  monotonous 
that  to  cite  one  or  two  instances  would  answer  for  a  whole  series. 
People  leading  more  or  less  eventful  lives  and  who  stand  out  in  a 
community  can  not  readily  be  cited  (except  of  course  those  coming 
from  a  distance),  but  now  and  then  an  individual  willingly  allows 
his  case  report  to  be  used  in  what  may  be  called  a  Missionary 
Spirit.  There  are  all  sorts  of  movements  in  which  people  enlist  as 
missionaries;  today  there  is  even  a  good  air  movement. 

A  Personal  Mention.  The  dust  victim  that  I  know  longest  is 
myself.  That  I  reacted  to  bad  air  conditions  I  first  fully  realized 
on  entering  medical  college.  Naturally  .1  have  given  the  subject 
of  bad  air,  of  dust  influences,  more  or  less  attention  ever  since.  In 
a  volume  like  this,  one  does  not  care  to  speak  about  oneself  but 
some  of  my  patients  have  allowed  me  to  use  their  case  histories  on 
condition  that  I  make  mention  of  ray  own. 

When  I  first  entered  medical  college  in  the  heart  of  a  large  and 
dirty  city  in  the  fall  of  1889,  I  had  a  constant  succession  of  "colds," 
with  catarrh  and  aching  throughout  the  body,  with  malaise  and 
finally  eye  trouble.  I  felt  bad,  I  was  not  really  sick  and  yet  I  was 
not  well.  Naturally  I  asked  advice  and  got  all  sorts  of  explanations 
(all  but  the  right  one),  as  well  as  all  kinds  of  prescriptions  and 
medicines  (all  but  the  right  kind).  One  soon  comes  to  question 
opinions  concerning  the  presence  of  diseases  as  opposed  to  ill  health. 
I  found  out  for  myself  that  I  was  reacting  to  bad  air,  not  alone  of 
the  college  whose  many  clinics  were  visited  by  all  sorts  of  sick 
people  and  where  ventilation  was  very  poor,  but  also  to  the  air  of 
the  heart  of  the  city  itself,  where  the  medical  student  rooms.  I 
had  always  been  used  to  good  air.  I  came  near  not  passing  through 
medical  college  at  all  on  account  of  ill  health.  When  I  got  back  to 
good  air  my  troubles  vanished,  but  every  now  and  then  I  had  an 


80  DUSTY   AIR    AND   ILL   HEALTH. 

acute  attack  and  1  naturally  attempted  to  trace  it  and  find  out  how 
I  "caught  cold/' 

After  a  number  of  years  spent  in  hospitals,  I  decided  to  make  a 
systematic  study  of  common  ill  health  dependent  on  bad  air,  i.  e., 
air  filled  with  infection  mainly  due  to  the  spitting  habit.  That 
was  the  kind  of  air  that  affected  me.  In  order  to  get  a  variety  of 
cases,  i.  e.,  a  variety  of  people  living  under  different  surroundings, 
including  country  people,  I  located  in  a  "spitter's  town,"  con- 
fining myself  to  "internal  medicine,"'  that  means  especially  to  ex- 
clude surgical  cases.  As  a  new  doctor  in  town  (in  1900)  I  natur- 
ally got  all  sorts  of  applicants  for  professional  services.  Old  chron- 
ics especially  seek  out  the  new  doctor,  hoping  he  may  have  some- 
thing that  will  cure  or  benefit  them.  Among  the  applicants  were 
some  who  reacted  to  bad  air  as  T  did:  I  understood  them  at  once 
and  my  advice  benefited  them.  But  there  was  a  large  number  of 
"old  chronics"  that  I  did  not  understand  and  in  a  short  time  they 
discovered  this  and  left,  to  try  somebody  else.  Gradually  I  learned 
that  many  "old  dyspeptics"  were  really  dust  victims,  that  expos- 
ures to  bad  air  were  followed  by  a  reaction  which  manifested  itself 
mainly  by  a  disturbed  alimentary  tract.  Later  I  found  that  in 
some  dust  victims  the  nervous  sj'stem  is  disturbed  and  still  later 
that  the  circulation  may  be  disturbed.  All  these  things  I  had  to 
learn ;  I  did  not  find  them  in  the  books.  Since  I  myself  had  only 
what  may  be  called  a  simple  form  of  dust  infection,  I  did  not  real- 
ize that  others  reacted  differently,  nor  that  as  people  grow  older 
they  may  react  more  acutely. 

In  time,  after  I  had  considerable  experience,  I  began  to  write 
papers  and  present  them  before  various  medical  and  scientific  so- 
cieties. I  not  only  wanted  to  tell  what  I  had  observed  but  I  also 
wanted  criticism,  wanted  to  learn  of  the  experiences  of  others. 

In  the  course  of  time  as  I  took  up  different  types  of  dust  vic- 
tims, I  had  to  abandon  earlier-studied  forms  on  account  of  limited 
time,  and  then  it  became  a  problem  what  to  do  with  applicants. 
One  cannot  briefly  refuse  an  old  chronic  who  has  had  years  of  ill 
health.    But  to  properly  work  out  a  case,  to  make  a  diagnosis  and 


DUST  AND  DUST  VICTIMS.  81 

at  the  same  time  rule  out  the  presence  of  definite  diseases,  often 
takes  much  time ;  and  then  too,  some  people  require  a  lot  of  expla- 
nation in  order  to  understand  and  follow  advice. 

In  publishing  papers  I  usually  obtained  a  lot  of  reprints.  These 
I  distributed  to  those  who  might  profit  by  them.  The  question  of 
gathering  together  papers  and  reprinting  them  or  of  getting  out 
and  publishing  a  volume  has  been  considered  for  several  years. 

Since  my  first  year  in  medical  college  I  have  not  beer,  exposed 
to  air  conditions  as  bad  as  those.  I  obtained  my  medical  degree 
from  a  smaller  school  in  a  smaller  city  where  air  conditions  were 
relatively  good.  They  were  bad  enough  but  comparatively  speak- 
ing they  were  fairly  good,  and  I  held  out  until  near  the  close  of  the 
year,  and  then  mucous  membranes  became  irritable,  and  that  is  apt 
to  make  one  feel  irritable  generally.  On  account  of  the  nearness 
of  the  eyes  to  the  irritated  air  passages,  the  eyes  became  affected 
and  since  then  I  have  been  compelled  to  wear  glasses.  During 
later  years  there  have  been  occasional  short  exposures  to  bad  air 
conditions  but  the  reaction  has  rarely  resulted  in  continued  colds 
or  in  purulent  catarrh.  The  transient  catarrh  has  been  of  the  mu- 
cous kind,  really  a  physiological  process  designed  by  nature  to  en- 
tangle solid  matter  inhaled  in  the  air,  enabling  one  to  cast  it  out. 
I  average  perhaps  two  decided  colds  a  year,  but  a  condition  which 
may  be  regarded  as  an  "incipient  cold"  or  threatened  cold  occurs 
frequently,  whenever  there  is  a  sufficient  exposure.  I  shall  refer 
to  this  again  later,  under ' :  Kinds  of  Colds. ' '  But  in  time  one  learns 
how  to  head  off,  especially  by  avoiding  additional  exposure  and 
spending  time  in  good  air. 

But  gradually  other  symptoms  of  dust  infection  appeared.  In 
other  words,  as  one  gets  older  the  disturbances  may  manifest  them- 
selves differently  and  in  different  parts  of  the  body.  Thus  since 
spraining  my  back  I  now  and  then  get  a  backache  after  being  ex- 
posed to  bad  air,  in  fact  at  times  a  mild  backache  may  be  the  only 
evidence  of  an  attack  of  dust  infection. 

At  first  when  I  discovered  I  was  a  dust  victim  and  could  not 
live  under  bad  air  conditions  as  others,  I  was  inclined  to  bewail 


82  DUSTY    AIR    AND   ILL   HEALTH. 

my  fate,  but  in  time  I  learned  that  there  are  compensations.  Be- 
cause I  am  susceptible  T  am  in  a  position  to  understand  those  who 
are  similarly  sensitive,  a  class  of  people  whom  the  physician  in 
robust  health  ma}'  wholly  misunderstand.  Today  many  complain 
of  ill  health  rather  than  of  disease:  there  are  many  who  have  ill 
health  to  one  who  has  well-defined  disease.  If  one  patient  in  fifty 
who  apply  to  the  physician  had  disease  and  died  the  race  would 
soon  become  extinct. 


The  reader  will  soon  notice  that  my  practice  differs  from  that 
customary  among  physicians,  the  reason  is  simple :  I  was,  and  still 
am,  after  data  regarding  common  ills  and  ill  health  and  causes, 
data  usually  obtained  with  difficulty.  The  practice  of  medicine  is 
greatly  simplified  by  calling  every  complaint  "disease,"  and  it  is 
still  more  simplified  by  merely  "treating"  cases  and  not  making 
any  inquires  about  causes  or  giving  advice  on  how  to  prevent  re- 
currences. 

In  questioning  old  chronics  who  have  had  much  experience 
among  physicians  one  constantly  meets  those  who  complain  of  not 
having  had  the  square  deal — and  physicians  complain  similarly. 
This  is  a  painful  subject.  Is  it  necessary  to  add  that  a  physician 
who  is  not  earning  enough  to  make  a  decent  living  in  time  loses 
interest  in  many  things  that  bring  in  no  returns? 

Does  it  pay?  is  a  question  constantly  heard  when  anything  new 
is  proposed.  Does  it  pay  to  give  attention  to  dust?  Here  and 
there  throughout  this  volume  I  have  asked  and  answered  this  very 
practical  question — but  each  man  must  find  his  own  answer. 

To  me  this  volume  is  of  value  in  that  it  enables  me  to  avoid 
lengthy  explanations  by  words  of  mouth  (not  to  speak  of  writing 
long  letters).  I  can  now  refer  people,  especially  new  patients,  to 
"my  book." 

There  is  an  old  saying,  God  helps  those  who  help  themselves. 
Concerning  the  "old  chronic"  who  has  ill  health  rather  than  well- 
defined  disease  (especially  he  who  reacts  to  bad  air)  one  may  par- 
aphrase:   The  physician  helps  those  who  help  themselves.     There 


DUST  AND  DUST  VICTIMS.  83 

must  at  least  be  full  co-operation — and  the  man  who  is  not  fully 
able  to  live  up  to  the  physician's  best  advice  is  to  be  pitied,  only 
too  often  he  is  left  to  his  fate. 

In  general  it  may  be  said  that  it  is  as  easy  to  get  data  on  the 
evil  influences  of  dust  among  poor  people  as  it  is  difficult  to  get 
data  on  good  air  influences — because  few  people  are  willing  or  able 
to  live  up  to  good  air  advice  with  all  that  this  implies. 

If  Pure  Air  could  be  bought  at  the  drugstore  (and  taken  with 
all  that  the  good  air  treatment  implies)  it  would  be  a  more  popular 
remedy  than  at  present. 

Since  this  is  not  a  systematic  treatise  but  merely  an  account  of 
my  work  and  observations,  the  personal  pronoun  I  constantly 
occurs. 

To  old  patients  and  to  friends  I  am  under  many  obligations  for 
data,  for  records,  for  newspaper  clippings,  for  references  to  liter- 
ature, and  for  criticism.    I  herewith  thank  them  all. 


84  DUSTY    AIR    AND   ILL   HEALTH. 

A  FEW  CASE  REPORTS  OR  CASE  HISTORIES  OF  SIMPLE 
DUST  VICTIMS 

G.  T.  Well  developed  fanner  boy  of  18  years.  Typical  history  of 
dust  iufection.  Every  time  he  goes  to  town,  or,  rather,  returns  from 
town,  he  feels  feverish,  followed  by  headache,  soreness  in  the  chest  and 
at  times  in  the  larger  joints,  with  profuse  expectoration. 

Excepting  much  hypertrophied  tissue  in  the  throat,  due  to  repeated 
inflammation,  I  could  detect  nothing  wrong  about  him.  He  seemed  to  be 
a  picture  of  health.  We  discussed  the  nature  of  the  difficulty  and  1 
advised  him  to  remain  away  from  town  or  to  go  only  on  wet  days,  when 
there  was  uo  dust.  He  has  since  acted  on  this  advice  and  gets  along  in 
comfort. 

This  was  the  only  case,  excepting  another  farmer,  where  the  patient 
himself  was  able  to  recognize  the  dust  as  the  one  factor  in  bringing  on 
the  illness. 

The  above  is  a  simple  "illustrative  case  report,"  taken  from 
a  paper  on  Dust,  A  Neglected  Factor  in  111  Health,1  which  I  pre- 
sented before  the  Indiana  State  Medical  Association,  1904. 

Since  I  had  seen  a  number  of  similar  cases,  I  at  once  "under- 
stood the  case."  As  a  matter  of  fact,  the  young  man  reacted  much 
as  I  did  myself  under  bad  air  conditions,  only  he  was  much  more 
susceptible.  That  I  promptly  classified  him  as  a  dust  victim  was 
of  course  natural. 

A  physician  constantly  finds  himself  in  the  position  of  a  novel 
reader  who  opens  a  book  in  the  middle  of  a  story :  he  wonders  how 
it  all  began  and  how  it  will  end.  But  the  novel  reader,  unlike  the 
physician,  can  readily  find  out.  The  amount  of  reliable  informa- 
tion a  physician  gets  from  people  regarding  their  past  lives  varies 
greatly;  as  a  rule  people  are  poor  observers  and  readily  forget. 
For  this  very  reason  it  is  really  the  exceptional  individual  who  gets 
the  physician's  best  attention,  who  gets  more  than  routine  attention. 

Such  an  individual  usually  gives  a  history  of  good  health  up  to 
the  time  of  going  to  school,  after  that  ill  health  or  attacks  of  ill 
health  may  be  common.  Many  country  children  promptly  react  to 
the  air  of  the  school  room ;  they  have  irritable  throats  and  more  or 


1  This  paper  was  written  mainly  in  general  terms  and  reprints  were  distributed  to  patients  and 
later  on  as  long  as  they  lasted  to  applicants  who  could  not  be  accepted  as  patients. 


DUST  AND  DUST  VICTIMS.  85 

less  inflammation  followed  by  scar  tissue,  as  in  the  case  just  men- 
tioned. There  may  be  adenoids  and  enlarged  tonsils,  defects  of 
sight  and  hearing,  etc.  Some  are  not  able  to  bear  school  life  at  all 
and  if  the  parents  persist  in  sending  such  a  child  it  is  likely  to 
perish.  The  very  fact  that  a  child  survives  school  life  must  be 
taken  as  evidence  that  something  can  be  accomplished  by  good  ad- 
vice regarding  the  future  of  the  individual.  To  what  extent  shall 
one  make  explanations  to  a  young  man  like  the  above? 

"We  all  make  explanations  by  drawing  analogies.  A  farmer  boy 
readily  understands  illustrations  drawn  from  plant  and  animal  life. 
In  this  case  I  explained  that  of  many  seedlings  comparatively  few 
develop  into  plants  that  produce  seed  and  are  able  to  reproduce 
themselves.  Plants  may  spring  up  so  thickly  that  there  is  a  struggle 
for  mastery  of  the  soil  and  many  perish.  A  late  frost  may  kill  or 
the  hot  rays  of  the  sun  may  be  fatal.  Too  little  or  too  much  moist- 
ure may  also  be  fatal.  Plants  must  run  the  gauntlet  of  destructive 
insects,  not  to  speak  of  being  destroyed  by  large  animals  or  by  man. 
Out  of  thousands  of  seed  or  wild  seedlings  only  one  or  two  may 
reach  maturity.  Then  too  some  plants  grow  only  in  certain  situa- 
tions. Plants  accustomed  to  the  shade  of  the  forest  are  destroyed 
when  the  forest  is  destroyed.  Others  are  destroyed  when  wet  places 
are  drained.  Then  again  some  plants  are  very  resistent;  they  are 
commonly  called  weeds. 

Somewhat  similar  remarks  may  be  made  regarding  wild  animals. 
Some  of  the  lower  animals  lay  thousands  upon  thousands  of  eggs 
and  yet  the  destruction  of  the  young  is  so  great  that  only  one  or 
two  reach  maturity.  Animals  are  constantly  warring  on  each  other. 
The  weak  fall  victims  to  the  strong ;  the  strong  may  fall  by  a  com- 
bined attack  of  the  weak. 

Cultivated  plants  and  domestic  animals  tend  to  survive  in  pro- 
portion as  man  gives  them  protection.  He  plants  seed  at  the  proper 
time  and  at  proper  distances  to  avoid  overcrowding,  and  he  pro- 
tects the  seedling  plants  from  destruction.  His  domestic  animals 
survive  in  proportion  as  they  are  given  protection.  If  left  to  na- 
ture they  would  quickly  perish. 


86  DUSTY    AIR    AND    ILL    HEALTH. 

Compared  to  animals,  man  takes  excessive  care  of  his  young, 
but  in  spite  of  all  his  care  there  are  always  some  individuals  who 
do  not  reach  maturity.  Many  children  are  born  under  unfavorable 
surroundings ;  like  plants  in  uncongenial  soil,  they  do  not  flourish. 
Some  perish  on  account  of  too  much  heat  in  summer  or  too  great 
cold  in  winter.  Many  perish  on  account  of  insufficient  food.  In 
the  slums  of  large  cities  the  death  rate  among  small  children  is 
terrific. 

In  the  average  isolated  country  home  children  are  apt  to  reach 
maturity;  comparatively  few  fall  by  the  wayside.  Many  children 
have  good  health  on  the  farm  but  the  moment  they  reach  school 
age  and  mingle  with  those  who  have  more  or  less  ill  health  or  dis- 
ease difficulties  arise.  We  all  know  how  on  the  opening  of  school 
the  acute  diseases  of  childhood,  notably  measles  and  scarlet  fever, 
at  times  become  epidemic.  This  is  the  time  too  for  colds  and  ca- 
tarrhs and  all  kinds  of  disturbances,  many  directly  traceable  to 
unsanitary  school  conditions  under  which  children  are  massed. 
School  children  are  like  plants  massed  in  a  hothouse :  great  care  is 
required  to  keep  off  disease.  Farmer  boys,  like  trees  taken  from 
the  forest,  do  not  tend  to  thrive  in  the  city.  They  may  drift  from 
one  occupation  to  another  and  still  complain.  Out  of  the  hundreds 
of  country  boys  who  try  city  life  only  a  few  succeed.  We  hear  of 
the  successes  but  not  of  the  failures. 

In  the  forest  a  tree  is  apt  to  grow  up  tall  and  slender,  with  a 
smooth  bark.  A  tree  transplanted  along  a  city  street  receives  all 
sorts  of  injuries,  the  bark  soon  becomes  disfigured  and  scarred,  the 
tree  itself  becomes  gnarled  and  decayed  at  heart.  A  child  in  its 
rough  and  tumble  plays  may  receive  all  sorts  of  bruises  and  in- 
juries, leaving  scars.  Infective  matter  produces  inflammations  and 
is  followed  by  scar  tissue.  Scarring  is  especially  common  where 
people  are  massed  closely  and  where  infection  readily  goes  from 
one  to  another,  either  by  contact  or  through  food  or  water  or 
through  the  air.  Children  growing  up  under  isolated  country  con- 
ditions and  not  constantly  coming  in  contact  with  infection  are 
apt  to  grow  up  well  formed,  with  straight  limbs  and  good  vision, 


DUST  AND  DUST  VICTIMS.  87 

like  the  Indian.1  On  the  other  hand,  children  growing  up  in  cities, 
especially  in  the  slums,  where  sanitation  is  neglected,  are  apt  to 
be  deformed ;  they  have  all  sorts  of  defects ;  many  have  an  old  age 
look. 

The  bodies  of  slum  people,  both  old  and  young,  when  examined 
at  city  hospital  morgues,  often  show  all  sorts  of  acute  inflamma- 
tions and  the  scars  of  old  ones.  Some  are  described  as  "patholog- 
ical museums,"  meaning  that  like  the  gnarled  tree  along  the  city 
street  there  has  been  a  many-sided  contact  with  destructive  agencies. 

When  we  examine  children,  as  in  a  medical  inspection  of  school 
children,  we  may  find  all  sorts  of  disturbances.  We  may  speak  of 
a  pathology  of  the  living.  Pains  and  aches  can  not  be  seen,  but 
we  can  see  the  effects  or  results  of  inflammations.  Thus,  looking 
down  the  throat,  we  may  find  it  full  of  abnormal  tissue,  some  in 
active  formation  and  some  as  scar  tissue.  On  account  of  the  diffi- 
culty of  air  getting  through  the  nose,  there  may  be  mouth  breath- 
ing. On  account  of  the  nearness  of  the  eyes  and  ears  to  the  air 
passages  where  infection  is  constantly  passing,  there  may  be  all 
sorts  of  disturbances  of  vision  not  to  speak  of  disturbances  in  the 
sense  of  taste  and  smell. 

In  a  general  way,  it  may  be  said  that  health  is  a  product  of  the 
country.  Ill  health  on  the  other  hand  is  due  mainly  to  the  massing 
together  of  people  in  towns  and  cities.  God  made  the  country  and 
man  made  the  town.  Our  towns  are  usually  so  unsanitary  that 
there  is  a  great  deal  of  preventable  ill  health  and  disease.  Here 
again  we  may  draw  an  analogy  between  human  beings  and  plants. 
Plants  growing  in  isolation  are  health}'  but  in  proportion  as  they 
are  massed  disease  is  apt  to  get  among  them.     The  florist  watches 


1  At  times  one's  work  passes  into  one's  dreams.  One  may  also  lie  awake  at  night  thinking  over 
one's  work,  not  to  say  dreams.  In  the  early  morning  hours  of  August  24,  1911,  I  had  a  vivid  dream 
in  which  I  saw  an  Indian  and  a  white  man  on  the  plain  (or  perhaps  I  was  looking  at  a  picture  of  such  a 
scene,  a  Remington  drawing,  perhaps).  Both  men  were  looking  into  the  distance.  The  Indian  stood 
up  straight  and  tall,  shading  his  eyes  with  his  hand.  The  white  man  was  slightly  stooped  and  slightly 
twisted  his  head  as  though  he  were  trying  to  focus  both  eyes  alike — after  the  fashion  of  the  school  boy 
who  twists  his  head  to  get  an  equal  focus  on  his  book. 

The  underlying  idea  of  course  was  this:  The  Indian  had  good  eyes,  the  white  man's  eyes  focused 
unequally  on  account  of  a  defect,  the  defect  being  due  to  his  (former)  mode  of  life  and  having  had 
infection  pass  from  the  nose  to  the  eyes  and  slightly  altering  them. 


88  Dl  STY    A  IK    .VXD    ILL   HEALTH. 

for  epidemic  diseases  that  threaten  his  plants,  his  knowledge  en- 
ables him  to  raise  fine  plants,  while  the  housewife  may  fail  to  winter 
over  her  single  houseplant. 

Only  a  few  weeks  ago  I  visited  a  farmer  who  has  a  "Seng 
patch."  Several  years  ago  he  found  several  ginseng  plants  in  the 
woods  and  planted  them  near  his  home.  The  next  year  he  got  a 
number  of  seed,  the  year  after  he  had  a  large  number.  He  then 
decided  to  make  a  regular  plantation.  The  plants,  several  thou- 
sand, were  close  together,  entirely  different  from  the  conditions 
under  which  they  grow  in  the  woods.  After  several  years  he  sud- 
denly discovered  that  some  disease  had  gotten  into  his  patch  which 
attacked  the  roots  and  killed  the  plants.  When  T  visited  the  patch 
he  lamented  the  fact  that  his  plants  were  dying  and  he  did  not 
know  what  to  do.  I  pointed  out  how  the  physician  sees  a  similar 
condition  of  affairs  where  people  are  massed  densely  in  slums  of 
cities.  Diseases  readily  go  from  one  to  another.  The  proper  rem- 
edy is  to  get  out,  to  get  more  breathing  space.  He  saw  the  appli- 
cation at  once,  that  patches  should  be  smaller  and  that  plants 
affected  should  promptly  be  taken  out  so  that  others  will  not  be 
attacked. 

One  may  go  a  little  further  and  explain  to  a  farmer  that  per- 
haps a  few  of  his  ginseng  plants  may  survive  and  that  by  taking 
seed  from  these  and  cultivating  he  may  in  time  produce  a  disease- 
proof  ginseng  plant,  just  as  we  have  rust  proof  oats.  But  such  an 
explanation  may  not  appeal  to  the  man  who  is  losing  a  valuable 
crop. 

The  evolutionist  might  say  that  nature  is  experimenting  on  a 
large  scale  in  producing  a  "disease  proof"  strain  of  man  by  elim- 
inating those  not  adapted  to  their  surroundings.  But  such  an  ex- 
planation does  not  appeal  to  parents;  they  are  not  interested  in 
future  generations  but  they  are  greatly  concerned  in  raising  their 
children.  They  see  the  importance  of  altering  the  environment  to 
make  the  conditions  for  their  existence  favorable. 

Even  the  physician  under  the  present  mode  of  practice  is  not 
concerned  with  the  future,  only  with  the  present.     Is  it  not  true 


DUST   AND  DUST   VICTIMS. 


89 


that  the  people  usually  come  to  him  only  for  a  "little  medicine"? 
The  matter  of  health  supervision  and  looking  ahead  is  in  its  infancy. 

To  what  extent  can  the  physician  speak  more  or  less  positively 
regarding  the  future  to  a  young  man  of  the  kind  here  under  dis- 
cussion? To  what  extent  will  he  take  special  pains  to  instruct 
bright  young  people  how  to  maintain  good  health,  to  reduce  symp- 
toms of  ill  health  to  a  minimum?  By  using  illustrations  and  anal- 
ogies like  the  above  they  may  be  led  to  understand  why  their  ills 
are  not  curable  by  the  use  of  medicine. 

As  already  mentioned,  this  patient  was  well  developed.  The 
only  visible  inflammations  and  scars  he  had  were  in  the  air  pas- 
sages. The  back  of  the  throat  is  a  better  guide  to  the  physician 
interested  in  air  conditions  than  the  tongue ;  dilated  capillaries  and 
distended  mucous  follicles  tell  tales.  A  "coated  tongue"  is  com- 
mon in  people  living  under  unsanitary  surroundings.  Some  pa- 
tients think  they  are  neglected  if  not  asked  to  "stick  out  your 
tongue. ' ' 

I  explained  his  ill  health,  his  attacks,  as  a  reaction  to  bad  air 
conditions,  that  he  had  no  definite  disease.  But  to  what  extent 
shall  the  physician  tell  of  the  possibility  of  real  disease  coming  on 
— that  nose  and  throat  manifestations  may  later  present  themselves 
in  the  lungs,  in  the  stomach,  or  in  the  cardio-vascular  system? 
Physicians  well  know  that  an  acute  pulmonitis  or  gastritis  or  ne- 
phritis may  follow  a  cold.  To  what  extent  do  physicians  speak  of 
these  things?  It  depends  on  the  physician  and  on  the  patient;  a 
doctor  is  not  necessarily  a  teacher,  and  there  are  people  who  do  not 
want  to  know  or  learn. 

What  will  be  the  outcome  ?  Perhaps  in  the  course  of  time  there 
may  be  so  much  scar  tissue  that  there  will  be  no  longer  any  com- 
plaint of  an  irritable  throat.  Scar  tissue  lacks  sensibility.  Then 
the  presence  of  infection  may  manifest  itself  elsewhere  and  per- 
haps differently.  It  is  interesting  to  watch  the  development  in  the 
course  of  years — but  unless  a  patient  reports  the  physician  is  left 
in  darkness  as  to  the  outcome. 

The  following  is  another  illustrative  case  report  taken  from  my 


90  DUSTY    AIR    AND   ILL   HEALTH. 

paper  on  Dust,  A  Neglected  Factor  in  111  Health.  The  case  is  that 
of  a  middle-aged  housewife  living  in  a  clean  part  of  the  city  and 
very  seldom  going  to  the  heart  of  the  city  or  into  crowds  because 
of  attacks  of  ill  health  that  follow.  She  belongs  to  that  class  of 
women  who  are  called  peculiar.  When  we  study  such  cases  we 
may  find  that  the  reason  people  are  considered  "peculiar"  is  quite 
simple. 

Mrs.  S.  Middle-aged  housewife.  History  of  frequent  headache,  vague 
wauderiug  paius  in  extremities  and  chest;  at  times  the  pains  are  severe, 
accompanied  by  a  disturbed  stomach  and  an  irritable  bladder;  attacks  last 
a  few  days.  Says  she  gets  sick  after  going  to  church  or  to  a  party,  and 
also  gets  sick  on  sweeping  in  the  house.  This  patient  dimly  recognized 
the  influence  of  dust,  as  I  soon  learned  without  asking  any  leading 
questions  along  the  line  of  dust  infection.  She  says  that  formerly  she 
could  not  take  a  ride  over  a  dusty  road  or  in  a  street  car  without  getting 
ill ;  she  goes  to  church  or  to  a  party  only  at  times  when  all  the  doors  and 
windows  are  open,  and  even  then  she  does  not  always  escape. 

This  case  belongs  to  that  class  of  women  who  regularly  have  a  "Blue 
Monday,"  the  result  of  house  cleaning  on  Saturday  and  attending  an  ill 
ventilated  church  on  Sunday.  After  the  source  of  the  "blueuess"  is 
pointed  out,  many  women  get  along  in  comfort  without  any  special  medi- 
cation. 

As  may  be  surmised,  I  promptly  tried  to  explain  that  she  was 
a  dust  victim.  As  mentioned,  she  herself  had  noticed  that  dust 
affects  her,  but  she  could  not  distinguish  between  kinds.  She 
could  not  understand  why  she  should  be  so  sensitive  and  why  her 
husband,  working  under  bad  air  conditions,  was  "thoroughly 
healthy. ' '  Pie  did  not  complain  although  he  had  some  catarrh ; 
she  did  not  consider  this  a  disease  because  "Everybody  had  ca- 
tarrh." She  herself  had  transient  mucus  formation  only  after  an 
acute  exposure. 

When  she  first  came  to  me  she  complained  of  pain  in  the  chest 
and  expressed  a  fear  of  consumption ;  at  the  same  time  she  told  me 
she  belonged  to  a  long-lived  family  and  that  there  was  no  consump- 
tion in  her  family.  Some  time  later  she  complained  of  pain  in  the 
stomach  and  then  expressed  her  fear  of  the  possibility  of  cancer, 
but  again  denying  any  such  disease  in  her  family.  Why  do  some 
people  alwaj's  look  for  the  worst?    (Some  physicians  do  the  same."! 


DUST  AND  DUST  VICTIMS.  91 

There  may  be  various  explanations  why  she  had  a  "good  family 
history,"  and  why  she  complained  much  of  ill  health,  while  her 
husband  did  not  complain.  I  explained  it  in  this  wise:  Her  hus- 
band came  direct  from  continental  Europe  where  his  ancestors  for 
ages  had  been  exposed  to  unsanitary  city  conditions  and  where  the 
weeding  out  on  this  account  was  severe.  He  might  be  considered 
as  a  survival  of  the  fittest,  able  to  live  under  more  or  less  unsani- 
tary surroundings.  Her  own  ancestry  goes  back  to  the  mountains 
of  the  south  where  under  simple  life  conditions  people  flourish  and 
where  there  is  little  weeding  out  on  account  of  unsanitary  condi- 
tions and  disease.  Practically  all  children  reach  maturity  and 
leave  offspring.  When  the  descendants  of  these  mountaineers  come 
to  live  under  unsanitary  city  conditions  the  weeding  out  process 
promptly  becomes  effective.  But  such  individuals  may  escape  pre- 
mature death  by  getting  out  in  time  or  by  avoiding  surroundings 
or  influences  that  produce  symptoms. 

This  patient  had  a  "good  family  history"  simply  because  her 
ancestors  had  not  been  exposed  to  the  cause  of  ill  health  and  dis- 
ease. She  herself  is  reacting  to  the  "diseases  of  civilization"  be- 
cause exposed  to  them.  She  largely  avoids  ill  health  or  disagree- 
able symptoms,  however,  by  staying  away  from  the  heart  of  the 
city  where  air  is  bad. 

One  day  she  expressed  her  belief  that  she  would  not  live  long, 
that  she  would  die  before  her  husband.  At  that  time  (1904)  I 
only  dimly  understood  how  men  who  complain  little  may  go  to 
pieces  suddenly  and  prematurely,  but  on  the  other  hand  I  knew 
that  "old  chronics"  tend  to  live  on  and  on.  Merely  to  console  her, 
I  told  her  how  old  chronics  by  being  prudent  live  on  to  old  age, 
their  symptoms  are  constantly  warning  them  not  to  go  to  extremes. 
At  that  time  I  did  not  realize  that  men  living  under  highly  un- 
sanitary air  conditions  may  and  do  react,  although  they  may  not 
complain  or  at  least  not  to  such  an  extent  that  they  will  consult  a 
physician,  that  instead  of  having  all  sorts  of  aches  and  pains,  colds 
and  coughs,  derangements  of  the  alimentary  tract  or  nervous  sys- 
tem, they  (the  body)  may  react  by  an  increase  in  the  blood  pres- 


92  DUSTY    AIR    AND    ILL    HEALTH. 

sure,  and  that  they  may  fail  suddenly  and  prematurely,  as  from 
an  apoplexy  or  from  Bright 's  disease.  I  may  here  add  that  since 
then  I  have  had  a  number  of  somewhat  similar  cases  and  at  times 
it  has  been  a  problem  to  what  extent  to  make  explanations  to  a 
"sickly  wife"  so  she  does  not  worry  on  account  of  the  "too  good 
health"  of  the  husband,  when  it  is  the  husband  who  is  in  danger  of 
dying  first. 

This  patient  was  kept  under  observation  for  several  years.  The 
idea  that  she  was  a  dust  victim  was  fully  verified.  She  is  alive 
today  and  has  better  health  than  she  had  for  years.  Her  husband 
died  suddenly  a  few  years  ago. 

The  reason  some  people  live  retired  in  town,  perhaps  on  the 
very  edge  of  it,  or  live  retired  in  the  country,  and  are  considered 
peculiar,  may  not  be  far  to  seek  in  the  light  of  such  cases.  The 
woman,  like  the  farmer  boy  just  cited,  had  learned  something  about 
her  limitations  and  tried  to  live  within  them.  But  she  did  not 
know  just  where  the  danger  lay — I  was  able  to  point  out  the  neg- 
lected factor.  Perhaps  the  reason  a  certain  class  of  individuals 
are  always  on  the  move  further  west,  feel  crowded  when  another 
settles  within  a  mile  of  them,  is  an  extreme  form  of  sensitiveness 
to  "crowd  poison." 

The  Arab  of  the  desert  is  said  to  be  so  sensitive  to  the  odors  of 
towns  that  he  does  not  enter  them.  Perhaps  he  has  noticed  the 
after-effects  and  avoids  them.  People  who  have  much  catarrh  and 
altered  nasal  membranes  may  be  wholly  unable  to  detect  odors. 
The  extent  to  which  the  inhabitants  of  some  of  the  small  towns 
tolerate  odors  arising  from  neglected  streets  is  remarkable.  The 
two  preceding  case  reports  as  originally  given  were  brief;  they 
were  "illustrative  case  reports."  There  was  nothing  said  about 
a  "cure." 

Now  when  a  physician  promptly  "cures"  a  patient  of  some 
acute  or  specific  disease,  the  ease  report,  if  he  reports  the  case,  may 
be  very  brief  and  to  the  point,  but  when  an  old  chronic  has  been 
with  a  physician  for  years  (greatly  benefited  but  still  uncured)  it 
becomes  a  problem  what  should  go  into  a  case  report  or  history. 


DUST  AND  DUST  VICTIMS.  93 

There  may  be  a  great  mass  of  data.  In  writing  a  volume  it  be- 
comes a  problem  what  to  include  and  what  to  exclude;  opinions 
may  differ  greatly.  A  weekly  or  even  a  monthly  note  in  the  course 
of  years  might  make  a  volume.  That  matters  of  interest  to  one  may 
not  be  of  interest  to  others  is  of  course  self-evident.  Indeed  case 
reports  by  physicians,  which  usually  relate  to  diseases  rather  than 
to  ill  health,  differ  greatly.  On  the  one  hand  are  those  given  in 
scientific  journals  of  limited  circulation:  they  may  be  so  dry,  "dry 
as  dust,"  that  few  read  them.  On  the  other  hand  are  those  writ- 
ten more  diffusely  for  the  popular  medical  journals.  As  a  rule 
case  reports  given  in  books  are  very  brief  and  lack  all  human  in- 
terest matter. 

Somewhat  similar  remarks  apply  to  biographies.  Few  are  writ- 
ten so  that  they  will  hold  the  interest  of  the  general  reader;  most 
of  them  are  written  by  specialists.  The  life  of  a  musician  is  usu- 
ally written  by  a  musician;  the  life  of  a  scientist  by  a  scientist. 
The  life  of  a  literary  man,  full  of  literary  criticism,  may  appeal  to 
comparatively  few  only,  more  popularly  written  it  may  appeal  to 
many.  The  biography  of  a  man  or  woman  of  varied  experience 
appeals  to  most  of  us.  The  biography  of  a  man  or  woman  who  had 
much  ill  health  may  appeal  only  to  those  who  have  apparently 
similar  ill  health.  Case  reports  here  cited  may  be  considered  as 
brief  or  partial  biographies  of  people  in  ill  health  or  they  may  be 
considered  as  a  chapter  out  of  their  lives. 


Of  the  two  case  histories  given,  the  first  is  that  of  a  young 
farmer  living  in  isolation;  the  second  is  that  of  a  middle  aged 
housewife  living  in  isolation  near  the  edge  of  town.  Here  I  shall 
give  the  history  of  a  young  woman  who  has  an  indoor  occupation 
in  the  heart  of  the  city.  She  is  relatively  immune.  When  on  a 
vacation  or  during  idleness  she  has  the  "best  of  health."  The 
ease  report  is  simple,  written  with  more  or  less  human  interest 
matter. 

Case  of  Miss  — .  A  young  woman  who  first  came  to  me  in  1902 
and  has  been  with  me  ever  since.     This  patient  reacts  only  when 


94  DUSTY    AIR    AND    ILL    HEALTH. 

air  conditions  are  very  bad,  being  able  to  withstand  a  large  amount 
of  infection,  or  in  other  words  live  in  spit  dust  air.  She  belongs 
to  a  long-lived  "weeded-out"  family,  her  parents  coming  from  a 
part  of  Germany  where  wars  were  frequent.  We  know  what 
crowding  into  fortified  cities  meant :  the  death  rate  was  terrific  on 
account  of  overcrowding,  bad  water,  insufficient  food  and  bad  air. 
It  was  the  "survival  of  the  fittest"  who  when  wars  were  over  went 
into  the  country  to  repeople  it. 

Her  home  is  in  a  part  of  the  city  where  air  conditions  are 
relatively  good.  There  are  five  brothers  and  sisters  living,  several 
having  died  in  childhood.  One  of  the  living  is  quite  susceptible 
and  is  constantly  subject  to  dust  infection,  and  it  would  seem  that 
it  was  mere  chance  that  this  one  survived.  I  can  readily  see  how 
if  there  were  removal  to  bad  air  conditions  weeding  out  would 
promptly  take  place.  Moreover  one  of  the  brothers  for  several 
years  was  exposed  to  bad  air  but  he  held  out  fairly  well;  since 
then  he  has  lost  his  immunity  and  now  complains  after  the  least 
exposure. 

I  shall  run  over  my  notes  very  briefly.  And  I  may  here  say 
that  when  she  first  came  to  me  I  took  few  notes  on  her  common 
colds,  as  I  already  had  many  case  reports  of  this  kind.  Often  it 
seemed  a  waste  of  time  to  take  notes  on  additional ' '  Simple  Cases. ' ' 
On  the  other  hand  during  the  last  few  years  the  patient  has  largely 
been  able  to  avoid  colds  and  ill  health  and  in  case  of  an  attack  took 
the  remedies  recommended,  without  consulting  me.  At  present  she 
consults  me  only  for  things  out  of  the  usual.  Even  the  simplest 
case  in  the  course  of  time  is  apt  to  give  one  interesting  data. 

Before  this  patient  came  to  me  she,  as  well  as  other  members  of 
the  family,  was  constantly  running  to  the  doctor  for  every  little 
pain  or  ache,  to  be  handed  a  bottle  of  medicine  or  a  box  of  pills. 
When  she  began  to  realize  what  the  symptoms  meant  and  to  what 
they  are  due,  she  became  indignant  at  the  practices  of  "symptom- 
prescribers. ' '  It  should  be  said  that  this  patient  has  a  clerical  po- 
sition and  has  changed  offices  several  times  and  according  to  whether 


DUST  AND  DUST  VICTIMS.  95 

the  office  is  sanitary  or  not,  that  is,  whether  the  air  conditions  are 
good  or  bad,  there  is  little  or  much  complaint. 

In  1902  when  she  first  came  to  me  she  was  complaining  of  a 
deranged  stomach,  with  backache  and  dizziness.  She  was  working 
under  horribly  bad  air  conditions.  I  promptly  ascribed  her  ill 
health  as  a  reaction.  As  she  was  a  sensible  young  woman  I  fully 
advised  regarding  good  and  bad  air.  By  reducing  the  length  of 
time  in  bad  air  and  increasing  the  time  in  good  air,  there  was  im- 
provement. 

Early  in  1903  she  was  greatly  run  down,  anemic,  with  a  weak 
heart  action  and  puffiness  under  the  eyes  and  complaints  of  dim- 
ness of  vision.  There  was  also  complaint  of  a  deranged  alimentary 
tract.  I  explained  to  her  that  evidently  she  was  ' '  full  of  infection ' ' 
and  advised  the  pure  air  treatment,  remaining  under  good  air  con- 
ditions as  much  as  possible.  But  just  then  her  work  required  much 
time  indoors  under  bad  air  conditions;  the  symptoms  continued 
until  the  open  door  season  was  well  advanced. 

In  1904  just  before  the  open  door  season  there  was  again  great 
complaint,  clearly  due  to  bad  air.  When  my  paper  on  Dust,  A 
Neglected  Factor  in  111  Health  appeared,  I  gave  her  a  copy  and 
she  then  gave  me  a  number  of  observations,  especially  of  times 
previous  to  coming  to  me,  of  attacks  that  she  now  clearly  traced 
to  bad  air,  as  going  to  the  skating  rink  where  the  floor  was  cov- 
ered with  powdered  pumice  stone  which  settled  over  everything. 
The  sharp  gritty  matter  was  of  course  mixed  with  more  or  less 
infected  matter  and  for  this  reason  purulent  catarrhs  were  quite 
common.  We  had  a  discussion  regarding  the  amusements  of  a 
small  town,  how  few  there  are  and  when  anything  does  go  on  the 
people  are  apt  to  go  frequently  until  the  novelty  wears  off  or  until 
they  notice  bad  effects.  A  number  of  my  patients  began  to  realize 
that  they  had  bad  health  on  account  of  attending  polo  games  at 
the  skating  rink. 

In  the  fall  of  1904  while  attending  the  State  Fair  she  got  a 
"bad  cold"  that  lasted  for  six  weeks.     This  cold  was  complicated 


96  DUSTY    AIR    AND    ILL    HEALTH. 

by  a  sore  foot.  On  inquiry  1  got  first  a  history  of  very  bad  air 
conditions  at  the  Fair  with  its  large  crowds,  with  practically  no 
ventilation  in  some  of  the  buildings.  It  seems  buildiugs  were  kept 
closed  to  keep  out  the  clouds  of  dust,  and  that  meant  to  confine  the 
dust  produced  inside,  especially  the  spit  dust.  Regarding  the  sore 
foot,  I  learned  that  when  she  was  nine  or  ten  years  old  she  sprained 
the  foot  and  that  for  several  years  it  was  sore  but  she  gradually 
got  over  it,  the  pain  returning  during  this  ' '  State  Fair  Cold. ' '  At 
times  she  complained  greatly.  Locally,  air  conditions  were  very 
bad  at  this  time  on  account  of  dry  weather,  and  she  continued  to 
complain  until  rains  set  in  and  cleared  the  air,  and,  more  impor- 
tant, washed  away  the  accumulated  filth  from  the  streets. 

Early  in  January,  1905,  she  had  a  severe  cold  which  assumed 
a  continued  form  and  annoyed  her  very  much  up  to  the  open  door 
season.  There  was  much  soreness  in  the  chest  and  general  aching 
throughout  the  body  and  the  foot,  with  of  course  sore  throat,  head- 
ache, deranged  alimentary  tract  and  general  weakness — one  might 
almost  term  it  nervous  prostration.  The  air  conditions  at  the  time 
were  bad  with  little  chance  to  increase  the  hours  in  good  air.  The 
pain  in  the  foot  was  especially  marked  at  ' '  darkest  before  dawn. ' ' 
In  midsummer  (1905)  there  was  an  attack  of  dust  infection  with 
deranged  stomach,  clearly  traceable  to  "indoor  climate"  under 
dusty  air. 

She  was  a  good  observer  and  told  me  of  a  number  of  her  obser- 
vations. Thus,  with  the  return  of  the  closed  door  season  one  of 
her  fellow-workers  went  to  a  polo  game  and  the  next  day  had  a  bad 
cold.  Games  were  played  twice  a  week  and  when  the  next  game 
came  she  again  went,  and  that  "did  her  up"  to  such  an  extent 
that  she  had  to  remain  at  home  several  days,  then  when  she  did 
return  she  was  scarcely  able  to  be  about  and  was  very  annoying 
to  others  in  the  office  on  account  of  her  coughing  and  complaining. 
My  patient  was  very  indignant.  She  said  she  tried  to  explain  the 
matter  to  her  but  got  scant  attention,  perhaps  some  ridicule.  It  is 
the  old  story  of  people  not  believing  in  the  injuriousness  of  dust. 
As  a  matter  of  fact  many  of  my  patients  realize  that  it  is  difficult 


DUST  AND  DUST  VICTIMS.  Vi 

to  explain  and  so  they  do  not  even  attempt  it.  It  has  frequently 
occurred  that  some  patients  would  not  even  explain  it  to  their  own 
relatives.     (In  this  connection  see  case  of  Miss  — ,  p.  202. 

Early  in  1906  and  up  to  the  open  door  season  there  was  much 
complaint  of  periodical  headaches.  For  a  time  she  remained  at 
home  entirely  and  during  this  time  had  "'good  health." 

She  has  frequent  occasions  to  be  at  the  Court  House  and  after 
the  election  in  November,  1906,  described  to  me  the  condition  about 
the  Court  House  where  there  had  been  an  election  booth.  The  spit 
conditions  must  have  been  awful.  This  was  an  acute  exposure, 
followed  by  an  acute  cold,  which  kept  getting  worse  until  she  finally 
came  to  consult  me. 

In  January,  1907,  she  was  complaining  greatly  of  aching  all 
over,  of  having  a  peculiar  feeling  '"as  though  getting  rheumatism." 
The  pain  was  first  noticed  in  the  sprained  foot,  gradually  spread- 
ing throughout  the  body.  I  have  a  short  note  referring  to  a  con- 
sultation regarding  the  onset  of  this  prolonged  attack,  that  it  was 
due  to  going  to  a  polo  game  but  that  for  a  time  she  concealed  this 
fact  from  me  from  fear  of  ridicule — it  is  the  old  story  of  expecting 
to  hear  "I  told  you  so."  I  may  add  that  the  "rheumatic  sensa- 
tions" were  most  marked  in  the  forearms;  one  might  almost  regard 
it  as  an  "  occupational  disease ; ' '  she  w  as  manipulating  the  type- 
writer most  of  the  time. 

It  is  customary  here  to  explain  many  obscure  attacks  of  ill 
health  not  otherwise  explainable  as  due  to  "grip,"  and  when  one 
day  she  came  in  it  began  to  look  as  though  she  had  "real  grip," 
that  is  influenza.  The  general  symptoms  gradually  subsided.  At 
"darkest  before  dawn,"  that  is,  the  middle  of  March,  she  came  in 
on  account  of  her  foot  which  continued  to  annoy  her.  She  said 
she  had  an  idea  what  I  would  say  regarding  treatment:  that  I 
would  advise  a  change  of  occupation,  to  get  into  better  air.  But 
she  did  not  see  her  way  clear  to  do  this,  and  hence  did  not  come 
in  to  report ;  she  now  came  only  because  a  sister  urged  her,  saying 
she  would  get  no  further  sympathy  unless  she  did  so.  This  con- 
tinued attack  was  traceable  to  handling  large  dusty  abstract  rec- 

[7] 


98  DUSTY   AIR    AND   ILL   HEALTH. 

ords,  thick  with  dust  and  in  a  room  that  practically  had  no  ven- 
tilation. She  clearly  recognized  the  relationship  of  cause  and  effect 
and  knew  that  as  soon  as  the  op«-n  door  season  arrived  she  would 
get  better.  Moreover  the  filth  conditions  in  town  were  very  bad 
at  the  time;  there  was  no  street  cleaning  and  filth  accumulations 
were  held  by  snow  and  ice.  This  filth  and  attendant  dust  (dust 
on  sidewalks  and  in  stores,  tracked  in  from  the  thawed  mass  on 
the  streets)  went  out  suddenly  with  a  heavy  rain  and  health  con- 
ditions improved.  She  herself  improved  as  soon  as  the  open  door 
season  arrived.1 

For  the  last  three  years  I  have  seen  little  of  her  because  she 
has  learned  her  limitations  and  tries  to  live  within  them.  She 
realizes  the  uselessness  of  medicine  in  effecting  a  permanent  cure 
and  its  limited  influence  in  acute  attacks,  and  yet  she  does  not  go 
to  the  other  extreme  of  laissez-faire.  She  knows  that  many  symp- 
toms can  be  modified  by  the  use  of  remedies. 

There  are  a  number  of  incidents  that  might  be  mentioned  along 
with  a  number  of  her  observations  but  here  I  have  room  for  only 
a  few. 

One  day  in  discussing  "Tax  Payer's  Colds"  she  told  me  of 
speaking  with  an  old  farmer  who  came  in  to  pay  taxes  for  a  number 
of  his  neighbors.  It  was  during  the  height  of  tax-paying  time  and 
it  required  several  hours  to  get  through  at  the  court  house,  and 
that  meant  that  the  long  line  of  tax  payers  had  to  wait.  I  can 
testify  to  the  horrible  spit  dust  air  conditions  prevailing  at  such 
times  in  a  small  room  full  of  tobacco-spitting  catarrh-afflicted  men. 
No  wonder  people  have  "Tax  Payer's  Colds." 

One  often  wonders  to  what  extent  one's  "preaching"  regarding 
the  dust  evil  and  the  importance  of  clean  air  is  productive  of  re- 
sults. I  have  been  preaching  so  often  and  so  long  that  at  times  I 
feel  almost  ashamed  to  bring  up  the  subject.  But  sometimes  one 
gets  evidence  that  there  are  results.  Thus  one  day  my  patient  told 
me  of  visiting  a  neighbor  who  had  a  "bad  cold."     She  had  just 


1  Her  employer  was  constantly  reacting  to  bad  air  without  however  realizing  it.  He  continued 
to  go  to  the  office  and  went  from  bad  to  worse,  until  he  finally  placed  himself  in  the  hands  of  a  surgeon 
but  alasi   too  late;   he  fills  a  premature  grave. 


DUST  AND  DUST  VICTIMS.  99 

returned  from  a  trip  to  Chicago.  Rather  to  ray  patient's  surprise 
she  said  in  a  matter  of  fact  way,  "I  guess  that  is  one  of  Dr.  Hess- 
ler's  dust  colds."     I  did  not  know  the  woman. 

By  way  of  summary  one  can  say  that  here  is  a  young  woman 
who  at  times  has  "common  colds"  which  under  bad  air  conditions 
"hang  on."  Coryza  at  times  may  he  very  marked  and  then  again 
absent.  At  times  there  are  dyspeptic  disturbances;  one  can  speak 
of  her  as  a  dyspeptic.  At  times  again  symptoms  referable  to  "nerv- 
ous prostration"  occur.  All  these  symptoms  are  dependent  upon 
bad  air,  or  to  be  specific,  on  spit  dust,  as  verified  over  and  over. 

There  is  one  other  point  that  might  be  mentioned.  The  patient 
regretted  that  the  history  of  a  relative  can  not  be  given  in  this 
connection,  one  very  susceptible  to  exposure  to  bad  air,  quickly 
manifested  by  irritable  respiratory  membranes  and  enlarged  lym- 
phatics. "Catching  Cold"  occurs  immediately  and  colds  hang  on; 
at  times  there  may  be  great  systemic  disturbances.  It  took  a  long 
time  for  this  relative  to  learn  to  live  within  limitations.  People, 
especially  young  people,  think  they  ought  to  be  able  to  do  as  others. 
For  instance,  after  having  good  health  all  through  the  summer 
with  free  ventilation,  the  going  into  the  first  social  gathering  or 
theater  in  the  fall  brings  on  a  prompt  reaction.  Or,  again,  during 
the  closed  door  season  after  having  had  good  health  by  living  in 
isolation  for  some  time  and  then  going  out,  perhaps  only  to  do  shop- 
ping, ill  health  comes  on. 

In  discussing  the  "Air  of  Places"  with  an  observant  patient 
of  this  kind,  one  may  get  all  sorts  of  information  regarding  com- 
parative air  conditions,  varying  from  good  to  very  bad.  The  sub- 
ject will  be  taken  up  subsequently.  It  may  here  be  said  that  it 
can  be  looked  at  from  two  standpoints,  locally  and  generally.  "What 
kind  of  air  do  we  encounter  in  our  daily  life  at  home?  on  the 
street  car?  at  the  office,  shop,  store  or  factory,  at  places  of  amuse- 
ment and  recreation?  And  on  the  other  hand  what  kind  of  air  do 
we  find  in  travelling  to  distant  countries?  Unless  our  attention  is 
called  to  it,  to  what  extent  do  we  consider  air  conditions  under 
which  we  live  ? 


100  DUSTY   AIR   AND  ILL   HEALTH. 

Formerly  she  became  alarmed  at  every  little  pain  and  ache. 
Her  physician,  inherited,  so  to  speak,  from  her  parents,  was  of  the 
simple  prescribing  kind :  he  gave  out  medicine  on  the  merest  state- 
ment of  symptoms  and  with  never  any  general  advice.  He  was 
truly  a  "medicine  man."  She  now  clearly  recognizes  the  relation- 
ship of  cause  and  effect,  but  being  compelled  to  work  for  a  living 
she  can  not  choose  air  conditions  to  her  liking.  As  a  consequence 
she  must  suffer  more  or  less.  One  may  say  that  if  the  community 
took  an  interest  in  sanitary  matters,  especially  in  giving  people 
good  air,  she  would  have  "perfect  health." 

The  amount  of  bad  air  and  infection  she  can  bear  is  really  re- 
markable. She  clearly  recognizes  this  (especially  when  contrasting 
herself  with  a  relative  who  is  very  susceptible)  but  feels  confident 
that  at  times  if  the  exposure  were  a  little  worse  or  longer  con- 
tinued, she  would  break  down.  As  a  well-known  young  woman 
and  valued  friend,  I  can  not  here  go  into  further  details  nor  state 
facts  on  which  conclusions  are  based. 

Cases  where  the  relationship  of  patient  and  physician,  or  phy- 
sician and  patient,  did  not  last  long  are  very  common.  The  length 
of  such  relationship  is  often  determined  by  what  is  called  tact. 
Deliberately  to  call  attention  to  what  might  be  regarded  as  "un- 
tidy housekeeping"  (in  the  following  case  not  really  so,  because 
the  house  was  old  and  high  winds  stirred  up  things)  is  usually  con- 
sidered highly  offensive,  just  as  pointing  out  untidy  and  unsanitary 
city  conditions  is  apt  to  give  one  the  reputation  of  being  a 
"knocker."  A  physician  has  "smoothest  sailing"  by  keeping  still 
and  merely  giving  what  is  wanted,  medicine. 

During  1902  I  made  many  visits  to  people  at  their  homes  (1 
had  an  automobile,  the  first  in  town),  but  I  soon  abandoned  this 
Although  one  sees  many  cases  one  is  not  apt  to  take  many  notes, 
one  may  be  too  tired  to  write. 

One  day  while  visiting  a  patient  a  neighbor  called  me  in  to  see 
her  old  mother,  whom  I  found  had  "winter  cough  of  the  aged." 
I  wrote  her  a  prescription  that  was  indicated,  to  palliate.     The 


DUST  AND  DUST  VICTIMS.  101 

next  day  she  again  asked  me  to  stop  in,  her  mother  was  worse, 
"coughing  harder  than  ever."  She  wanted  to  know  whether  I  had 
not  given  the  "wrong  medicine." 

On  my  first  visit  I  had  laid  my  medicine  case  on  top  of  the 
dresser,  the  only  furniture  in  the  room  besides  the  bed  and  two 
chairs.  I  did  this  again  the  second  day,  when  I  noticed  that  there 
was  a  heavy  layer  of  dust  on  it.  T  drew  my  finger  through  it,  trac- 
ing d-u-s-t.  I  at  once  saw  why  the  old  lady  was  "coughing  worse 
than  ever ; ' '  there  had  been  a  strong  wind  storm  all  night  and  the 
dust  had  been  blown  out  of  cracks  and  crevices  of  the  old  loosely 
jointed  flooring;  naturally  the  cough  was  aggravated.  I  explained 
that  it  was  not  the  medicine  that  aggravated  the  cough  and  then  1 
pointed  out  what  I  had  traced  on  top  of  the  dresser.  The  daughter 
was  greatly  offended  and  I  was  not  called  into  that  house  again — 
perhaps  if  she  sees  this  volume  she  will  understand  the  relationship 
of  cause  and  effect.  A  heavy  layer  of  dust  on  furniture  is  good 
evidence  that  dust  must  have  been  inhaled.  It  is  in  the  air  before 
it  settles  down. 

Seasonal  Factor.  This  is  an  expression  I  constantly  use  in 
explanations  to  patients.  It  refers  especially  to  the  open  and  closed 
door  season.  In  the  summer  time  there  is  free  ventilation  and 
infective  dust  on  streets  and  sidewalks  is  sterilized  by  the  bright 
rays  of  the  sun.  In  the  winter  time  on  the  other  hand  doors  and 
windows  are  closed,  people  house  themselves  closely.  When  the 
sun  is  low  in  the  horizon  or  hidden  by  clouds,  infection  remains 
active.  Filth  tracked  in  remains  virulent  for  a  long  time.  Many 
ailments  are  seasonal.  Dust  infection  is  most  prevalent  during  the 
closed  door  season. 

Darkest  Before  Dawn.  This  refers  to  the  time  when  dust 
infection  is  at  its  height,  on  the  close  of  winter.  This  is  the  time 
when  patent  medicine  advertisements  are  at  their  maximum,  when 
the  doctors  are  busiest  and  the  sick  most  commonly  make  a  change, 
going  to  some  new  doctor  or  trying  some  new  nostrum.  An  indi- 
vidual may  have  been  complaining  all  winter  and  then  tries  a  new 


102  DUSTY    AIR    AND   ILL    HEALTH. 

doctor  or  a  new  medicine  and  in  a  short,  time  improves,  on  the 
return  of  the  open  door  season  (seasonal  influence).  Many  people 
have  a  distinct  idea  that  they  get  better  every  spring,  no  matter 
what,  they  take.  Unfortunately  the  remedies  that  "bring  back 
health"  in  the  spring  are  unable  to  maintain  health  on  the  return 
of  the  closed  door  season.  Many  have  an  idea  that  the  blood  needs 
purifying  in  the  spring,  they  take  a  "blood  purifier."  Some 
farmers  on  poor  soils  where  sassafras  grows  come  to  town  and  sell 
sassafras  root.  Greens  also  have  a  reputation  for  being  "good  for 
the  blood." 

The  Neglected  Factor,  the  Missing  Factor,  or  the  Common  Fac- 
tor are  other  expressions  frequent  in  my  case  reports.  What  they 
mean  must  be  self-evident  to  the  reader  by  this  time. 


IV. 
COLDS  AND  CATARRH. 


Everybody  knows  what  a  cold  is  because  practically  everybody 
now  and  then  has  one.  Catarrh  is  also  very  common,  indeed  some 
believe  that  "Everybody  has  catarrh."  As  a  matter  of  fact  some 
people  are  very  susceptible  to  colds  and  catarrh,  others  quite  re- 
sistent ;  conditions  must  be  very  bad  before  some  are  attacked,  that 
is  before  they  react. 

Colds  as  we  all  know  are  most  prevalent  during  the  cold  or 
closed  door  season.  Many  believe  that  colds  and  cold  are  related, 
but  when  we  critically  study  a  large  number  of  cases  we  may  come 
to  the  conclusion  that  there  is  something  else  at  bottom.  Colds  and 
catarrh  like  everything  else  of  course  must  have  a  cause.  In  the 
absence  of  a  cause  there  will  be  no  effect.  Because  of  the  belief 
that  "Everybody  has  catarrh"  many  fail  to  make  an  effort  to  find 
out  the  reason.  If  people  went  to  a  country  where  catarrh  is  not 
common  they  might  be  induced  to  ask  themselves  why  it  is  so  com- 
mon at  home.  Then  perhaps  they  may  see  that  Dickens  was  jus- 
tified in  speaking  of  "American  Catarrh." 

The  terms  cold  and  catarrh  are  old  names  and  of  indefinite 
application.  They  correspond  to  such  names  as  tree  or  house. 
There  are  all  sorts  of  trees  and  there  are  all  sorts  of  houses.  The 
same  criticism  applies  to  many  other  terms  that  are  used  in  regard 
to  symptoms  of  ill  health  and  disease.  A  physician  may  spend 
much  time  in  attempting  to  learn  what  his  patients  mean  by  certain 
terms. 

The  terms  cold  and  catarrh  are  often  used  interchangeably. 
Some  speak  of  catarrh  when  others  speak  of  colds.  Then  we  hear 
of  colds  changing  into  catarrh,  and  chronic  colds  are  referred  to  as 
catarrh.    A  patient  may  speak  of  a  cold  in  the  nose  while  his  phy- 

(103) 


10-1  .'1  -IV    A1K    AND    11. L    HEALTH. 

sician  may  call  it  an  acute  catarrhal  rhinitis,  literally  an  acute 
catarrh  of  the  nose.  The  physician  likely  speaks  of  a  cold  in  the 
throat  (manifesting  itself  also  in  the  nose)  as  an  acute  coryza,  if 
not  as  an  acute  pharyngitis  or  laryngitis.  Both  physician  and  pa- 
t  i i * 1 1 1  recognize  the  fact  that  there  is  an  irritation  of  the  mucous 
membranes  with  the  formation  of  more  or  less  mucus.  The  term 
catarrh  primarily  means  a  flowing  down.  One  can  readily  under- 
stand why  a  cohl  characterized  by  the  production  of  much  mucus 
should  be  called  catarrh  and  similarly  why  continued  colds  should 
be  given  the  same  name. 

An  irritation  of  the  respiratory  membranes  may  be  brought  on 
by  or  through  man}'  substances.  We  know  what  happens  when 
peeling  strong  onions,  how  the  air  passages  and  the  mucous  mem- 
branes of  the  eyes  will  be  irritated.  Those  subject  to  "hay-fever" 
begin  to  react  as  soon  as  certain  plants  begin  to  bloom.  People  who 
inhale  much  dust,  as  for  instance  railroad  firemen,  have  constant 
irritation  of  the  respiratory  membranes. 

The  tendency  to  catarrh  is  very  marked  in  some  individuals. 
Old  physicians  spoke  of  a  catarrhal  diathesis.  Now  and  then  we 
hear  physicians  speaking  of  "'poisoned  secretions."  Besides  the 
catarrh  proper  there  may  be  all  sorts  of  symptoms  accompanying 
the  mucus  formation  and  perhaps  in  the  end  leading  to  all  sorts  of 
"diseases,"  as  bronchitis,  consumption  of  the  lungs,  dyspepsia,  in- 
testinal derangement,  etc.  Mucus  may  pass  from  the  kidneys  in 
the  form  of  casts  and  be  misdiagnosed  as  Bright's  disease.  The 
maker  of  a  widely  advertised  nostrum  or  patent  medicine  says  that 
nearly  all  ills  and  diseases  are  due  to  catarrh.  There  is  certainly 
much  truth  in  such  a  statement,  but  we  must  at  once  inquire,  What 
makes  catarrh  so  common  in  our  country  and  why  the  need  for  so 
many  advertised  catarrh  remedies? 

We  should  keep  in  mind  that  there  are  two  classes  of  catarrhs 
or  colds,  the  infective  and  the  non-infective,  those  that  go  from  one 
individual  to  another  and  those  that  do  not.  Common  colds  and 
common  catarrh  go  from  one  to  another  just  as  the  seed  of  weeds 
travels  from  one  field  to  another,  while  such  affections  as  rose  cold 


COLDS  AND   CATARRH.  105 

qnd  autumnal  catarrh  or  hay-fever  manifest  themselves  only  in 
those  who  are  susceptible.  In  other  words,  one  does  not  "catch" 
hay-fever  from  another.  The  individual  subject  to  hay-fever  can 
go  to  a  country  where  the  particular  pollen  that  affects  him  is  ab- 
sent and  thereby  escape  an  attack.  But  the  individual  who  is  sub- 
ject to  common  colds  and  common  catarrh  is  less  fortunate;  he  is 
constantly  coming  in  contact  with  people  from  whom  he  is  liable 
to  "catch"  colds  and  catarrh.  Colds  and  catarrh  are  more  common 
in  some  communities  than  others.  They  are  more  common  in  the 
northern  states  where  people  are  massed  together  than  in  the 
warmer  southern  states  where  people  live  more  out  of  doors.  For 
the  same  reason  colds  are  less  common  with  us  in  summer  than  in 
winter  when  people  lead  an  indoor  life. 

"American  Catarrh/'  Europeans  tell  us  that  catarrh  is  much 
more  common  in  our  country  than  in  Europe,  an  idea  verified  by 
our  own  countrymen  who  have  been  to  Europe.  I  recall  that  as  a 
boy  I  heard  a  recently  arrived  German  immigrant  complain,  say- 
ing he  suspected  he  was  ' '  getting  the  American  catarrh. ' '  Charles 
Dickens  in  his  Letters  from  America  while  on  his  reading  tour 
complains  of  an  "American  Catarrh"  and  how  closely  it  stuck  to 
him.  He  also  writes  about  the  American  spitting  habit  and  here 
T  believe  we  at  once  find  the  explanation.  He  used  the  terms  colds 
and  catarrh  interchangably,  now  one  and  then  the  other.  As  al- 
ready mentioned,  European  physicians  speak  of  our  Triad  of  Amer- 
ican Diseases — catarrh,  dyspepsia,  and  nervous  prostration,  and 
here  again  we  can  trace  relationships. 


106  DUSTY    AIR    AND    ILL    HEALTH. 

KINDS  OF  COLDS. 

A  cold  may  be  regarded  as  a  reaction.  Individuals  react  differ- 
ently and  there  are  different  kinds  of  colds,  as  there  are  different 
kinds  of  causes.  Some  react  very  promptly  and  energetically, 
others  scarcely  at  all.  Some  are  very  susceptible,  others  practically 
immune.  Some  require  much  exposure  to  the  cause,  others  little. 
An  organ  or  one  part  of  the  body  may  react  more  strongly  than 
another;  a  cold  may  localize  in  some  part  of  the  body. 

In  this  volume  the  term  cold  is  used  as  a  synonym  for  dust  in- 
fection. Some  dust  victims  very  readily  contract  common  colds 
while  in  others  there  may  be  a  different  manifestation,  a  disturb- 
ance of  the  alimentary  tract,  of  the  nervous  or  circulatory  systems, 
etc. 

I  have  in  mind  one  of  my  patients  who  classified  his  colds  ac- 
cording to  the  place  where  or  the  conditions  under  which  he  caught 
them.  He  was  the  son  of  a  well-to-do  farmer  and  came  to  me  while 
in  high  school,  years  ago.  While  attending  the  common  schools  he 
had  "school  colds,"  with  much  coughing.  In  the  high  school  he 
also  had  colds  with  more  or  less  catarrh,  that  is  more  or  less  con- 
stant abnormal  secretions  from  the  respiratory  mucous  membranes. 
While  attending  college  in  a  clean  college  town  he  largely  escaped, 
but  during  this  time  he  occasionally  had  "railway  colds,"  "theater 
colds,"  "dance  hall  colds,"  etc.  I  was  led  to  classify  my  own 
notes  on  colds  under  such  and  similar  headings. 

It  might  be  added  that  he  soon  learned  how  to  reduce  attacks 
to  a  minimum  and  that  his  parents  were  subject  to  high  blood  pres- 
sure. His  colds  now  tend  to  manifest  themselves  differently,  that 
is  besides  common  colds  there  may  be  a  disturbance  in  the  circu- 
lation. 

The  following  list  of  colds  is  not  to  be  regarded  in  the  light  of 
a  scientific  statement  of  facts ;  it  is  merely  a  practical  classification 
of  common  colds.  Out  of  the  "fifty-seven  varieties"  I  can  make 
mention  of  only  a  few.  The  remarks  are  to  be  regarded  as  sug- 
gestive, to  lead  the  individual  subject  to  colds  to  ask  himself  how 
and  under  what  conditions  he  got  his  cold. 


COLDS   AND    CATARRH.  107 

Attic  Colds.  Among  my  early  patients  was  a  middle  aged 
housewife  who  occasionally  went  into  an  attic  to  look  over  old  mag- 
azines and  books.  She  would  almost  invariably  have  a  cold  after- 
wards. At  that  time  it  had  not  occurred  to  me  to  classify  colds  or 
I  might  have  spoken  of  "attic  colds,"  but  I  did  speak  to  her  about 
there  being  more  or  less  infection  in  such  dust,  depending  largely 
on  the  location  of  the  house  and  the  amount  of  infected  dust  car- 
ried or  blown  in. 

I  have  observed  similar  cases  now  and  then.  About  three  years 
ago  an  elderly  housewife  whom  I  had  sometime  before  accepted  as 
a  patient  came  in  one  day  with  a  severe  cold,  saying  she  had  had 
similar  colds  in  years  past.  She  ascribed  it  to  draughts  or  to  put- 
ting the  hands  into  cold  water.  I  promptly  told  her  it  was  an 
attack  of  cold  due  to  the  inhalation  of  dust.  She  realized  that  she 
had  inhaled  dust  freely  from  the  fact  that  she  had  been  spitting 
black.  Subsequently  she  found  it  was  more  profitable  to  let  some- 
body else  do  the  cleaning  up  of  the  attic. 

Automobile  Colds.  Patients  at  times  complain  of  having 
caught  a  cold  during  an  automobile  ride.  I  at  once  inquire  re- 
garding the  streets  or  roads  traversed.  One  quickly  discovers, 
assuming  that  there  had  been  no  exposure  otherwise,  that  riding 
over  dusty  down  town  streets  may  be  followed  by  a  cold,  but  that 
this  does  not  occur  on  a  ride  over  country  roads,  dusty  as  they 
majr  be.  Some  individuals  who  can  not  ride  about  city  streets  (or 
in  a  railway  coach)  without  getting  ill  can  take  long  automobile 
rides  over  country  roads  and  feel  good  afterward.  It  is  some- 
times said  there  is  nothing  new  under  the  sun  but  the  ancient 
Greeks  certainly  knew  nothing  of  automobile  colds,  although  the 
old  Romans  perhaps  had  chariot  race  colds. 

Book  Dust  Colds.  These  are  apt  to  occur  in  the  susceptible 
on  handling  old  books  and  especially  books  obtained  from  libraries 
in  the  heart  of  a  city,  particularly  old  books  that  have  rough  tops 
which  accumulate  a  large  amount  of  dust.  Sometimes  people  feel 
too  ill  to  be  about  yet  will  lie  on  a  couch  with  a  book  held  above 
them.    There  may  not  only  be  colds  and  irritation  of  the  respira- 


108  DUSTY    AIR    AND   ILL    HEALTH. 

tory  mucous  membranes  but  also  irritated  eyes,  and  then  the  spec- 
tacle man  may  advise  the  use  of  glasses.  Some  advertise  "Exam- 
ination free;"  one  wonders  what  such  examinations  amount  to. 

Carpet  Colds.  A  mention  of  carpet  colds  is  frequent  among 
my  case  reports.  One  may  speak  of  varieties,  as  where  a  crowd 
of  children  visit  the  grandparents  and  fill  the  house  with  dust,  or 
at  a  Christmas  entertainment  at  a  church  with  an  old  dusty  car- 
pet on  the  floor.  Then  there  is  the  dust  from  carpets  at  the  an- 
nual housecleaning.  A  carpet  cleaning  establishment  sending 
clouds  of  dust  into  the  air  may  be  the  source  of  continued  colds 
for  a  whole  neighborhood.  It  is  strange  that  such  establishments 
are  allowed  to  exist  in  a  town  but  they  do  exist  where  the  people 
are  negligent. 

Church  Colds.  One  of  my  newly  accepted  patients  com 
plained  of  having  Blue  Mondays,  with  more  or  less  cold  and  cough 
and  catarrh.  She  went  to  a  church  near  the  heart  of  a  city  that 
had  an  old  dirty  carpet  on  the  floor.  A  physician  never  knows 
how  people  will  take  his  remarks  that  reflect  on  their  church  going 
and  so  I  explained  in  a  round-about  way  about  dust  infection, 
also  how  people  get  colds  and  all  sorts  of  disturbances  on  going 
to  a  poorly  ventilated  theater.  She  promptly  said  she  did  not 
believe  in  people  going  to  theaters;  it  served  them  right  if  they 
got  sick.  Such  a  remark  is  a  straw  that  showed  her  attitude  re- 
garding theater  going  and  church  going.  Now  a  physician  after 
he  has  seen  a  large  number  of  cases  of  a  certain  kind  and  does  not 
care  about  having  more  of  the  same  kind  may  speak  plainly.  If 
his  explanation  is  accepted  in  the  proper  spirit  he  may  accept  the 
applicant  as  a  patient;  if  not  there  will  not  be  established  the 
relationship  of  physician  and  patient  or  patient  and  physician. 
I  promptly  told  her  I  believed  her  Blue  Monday  was  due  to  going 
to  church  on  Sunday.  She  was  at  first  inclined  to  deny  it  but  she 
agreed  to  observe.  Occasionally  remaining  away  from  church 
soon  convinced  her  that  her  attacks  were  "church  colds."  It  may 
be  added  that  this  really  is  one  of  the  most  serious  kinds  of  cold, 
from  the  fact  that  many  people,  especially  old  people,  think  they 


COLDS  AND   CATARRH.  I'1!) 

must  go  to  church.  Physicians  are  often  accused  of  being  ma- 
terialists; we  can  readily  understand  why  some  physicians  if  they 
insist  that  advice  regarding  physical  health  be  followed,  will  get 
such  a  reputation. 

Court-house  Colds.  A  large  chapter  could  be  written  under 
this  head.  From  the  fact  that  in  the  average  county-seat  the  court- 
house is  a  sort  of  social  center  for  men,  that  the  court  room  often 
is  overcrowded,  one  can  see  how  colds  are  carried  from  one  to  an- 
other. Then  too  clubs  and  societies  and  associations  may  use  the 
court  room  as  a  meeting  place.  Teachers'  Institutes  are  often 
held  there.  Sometimes  members  of  a  church  who  have  no  build- 
ing of  their  own  may  meet  in  the  court-house  on  Sundays.  Then 
too  we  must  consider  the  officials  who  all  day  long  inhale  court- 
house air,  usually  pungent  with  the  odor  of  tobacco,  not  alone  of 
smoke  but  also  of  quids;  some  bear  court-house  air  without  com- 
plaining, others  complain  greatly. 

Court-house  air  is  especially  severe  on  the  retired  farmer  who 
comes  to  town  and  has  little  to  do. 

Dance-hall  Colds.  Dance  halls  differ  widely  according  to 
their  location  and  the  kind  of  people  who  visit  them  and  their  air 
conditions.  A  clean,  well-ventilated  dance  hall  with  a  waxed  floor 
and  with  the  dancers  coming  in  carriages  is  a  vastly  different  thing 
from  a  dance  hall  with  a  rough  floor  to  which  women  come  with 
their  street  dresses  that  have  trailed  over  filthy  sidewalks.  When 
the  hygienist  advises  dancing  as  a  healthful  exercise  he  likely  has 
in  mind  open  air  dances  or  at  least  a  hall  that  is  clean  and  well 
ventilated. 

A  physician  can  never  be  sure  how  fully  his  advice  is  followed  ; 
some  patients  live  up  to  the  letter  but  not  to  the  spirit  of  his  ad- 
vice. One  of  my  patients,  for  instance,  who  frequently  went  to 
dances  and  as  a  consequence  had  continued  colds  and  sore  throat, 
discontinued  dancing  but  still  went  to  dances  as  a  "wall  flower." 
The  simple  injunction,  "Do  Not  Dance,"  is  not  sufficient;  one 
must  say,  "Do  not  go  to  dance  halls,"  meaning  of  course  those 
where  air  conditions  are  objectionable. 


110  DUSTY   AIR   AND   ILL    HEALTH. 

Space  forbids  enumerating  the  many  different  kinds  of  colds 
on  which  1  have  notes,  but  I  want  to  make  mention  of  a  few  addi- 
tional ones. 

Housecleaning  Colds.  These  are  very  common,  especially 
among  housewives.  There  are  two  periods  when  they  prevail,  at 
the  annual  spring  housecleaning  and  at  the  fall  housecleaning. 
It  is  customary  to  have  a  thorough  housecleaning,  perhaps  a  reno- 
vating, in  the  spring,  with  a  minor  one  on  the  approach  of  cooler 
weather.  During  the  summer  the  housewife,  in  fact  the  house- 
hold, may  have  had  good  health;  doors  and  windows  were  open, 
there  was  free  ventilation.  Then  come  the  cooler  days  and  doors 
and  windows  are  closed,  ushering  in  seasonal  ailments,  aggravated 
by  the  fall  housecleaning.  Some  people  have  colds  and  catarrh 
all  through  the  winter  which  reach  their  maximum  with  the  spring 
housecleaning.  Then  comes  a  period  of  good  health  or  at  least 
improved  health.  The  husband  usually  escapes  housecleaning 
colds,  but  if  he  helps,  as  taking  up  the  carpets,  he  too  may  suffer. 

Railway  Colds.  I  have  already  referred  to  the  fact  that  some 
people  can  not  take  a  ride  in  a  railway  coach  without  getting  ill. 
This  is  especially  true  during  the  cold  season  of  the  year.  But 
when  one  critically  studies  the  subject  one  finds  a  marked  differ- 
ence in  railway  coaches.  We  need  only  consider  the  kind  of  air 
to  be  found  in  a  Pullman  coach  and  the  kind  of  people  who  use 
it,  and  on  the  other  hand  the  air  of  a  smoking  car  on  a  small  local 
train,  patronized  by  the  tobacco  chewer  and  spitter,  with  an  odor 
so  overpowering  that  many  men  will  not  enter  it.  Besides  in- 
fective dust  proper  there  is  of  course  the  cinder  dust  from  the 
locomotive  and  the  dust  stirred  up  from  along  the  roadbed. 

It  is  sometimes  said  that  air  conditions  of  trolley  cars  are  su- 
perior because  there  is  no  smoke  and  no  dust  from  cars  ahead, 
but  according  to  my  observations  more  spitters  travel  on  trolley 
cars  than  in  day  coaches  of  through  passenger  trains.  Moreover 
many  railway  companies  have  a  very  efficient  system  of  ventila- 
tion.   Although  smoke  and  cinders  come  in,  yet  there  may  be  prac- 


COLDS   AND   CATARRH.  Ill 

tically  no  infective  dust.  From  personal  experience  I  know  1  can 
travel  on  clean  through  passenger  trains  (not  being  a  smoker  I 
never  travel  in  a  smoking  car)  with  comfort  but  I  can  not  say 
the  same  of  the  average  trolley  car.  I  have  a  lot  of  data  from 
travelling  men  who  observe  conditions.  They  say  the  man  who 
spits  tobacco  juice  travels  by  the  cheapest  mode;  that  means  he 
travels  in  a  trolley  rather  than  in  a  through  passenger  coach  or 
in  a  Pullman. 

School  Colds.  These  are  especially  important.  A  child  may 
have  had  good  health  up  to  the  time  of  going  to  school,  then  there 
may  be  a  succession  of  colds,  if  not  constant  colds.  Moreover  the 
colds  are  brought  home  to  the  other  children  and  to  the  mother.  The 
fact  that  the  specific  diseases  of  childhood  are  disseminated  at  the 
school  house  is  well  known.  Parents  are  likely  to  keep  their  chil- 
dren at  home  at  times  of  an  epidemic  of  measles  or  scarlet  fever. 
That  colds  are  similarly  distributed  seems  to  be  known  to  but  few 
parents.  Cleanliness  and  thorough  ventilation  are  the  best  pre- 
ventative, not  only  of  school  colds  but  also  of  the  common  diseases 
of  childhood. 

School  colds  form  a  frequent  subject  of  discussion  with  par- 
ents. Often  when  parents  learn  why  their  children  or  perhaps  an 
only  child  has  so  many  colds  and  so  much  continued  ill  health 
they  become  indignant.  When  unsanitary  school  conditions  are 
pointed  out,  they  exclaim,  "They  ought  not  to  be  allowed  to  ex- 
ist." Of  course  not  but  who  is  to  alter  or  prevent?  "Well,  the 
teachers  ought  to  look  after  the  matter. ' '  So  they  ought ;  but  we 
know  they  do  not.  "Well,  the  School  Board  ought  to  look  after 
it. ' '  True,  but  the  fact  is  they  do  not.  ' '  Well,  the  Board  of  Health 
should  compel  the  school  authorities  to  make  the  school  sanitary.'1 
Of  course ;  but  as  a  rule  such  Boards  fail  to  do  so — why  ?  Because 
the  people  fail  to  look  after  health  matters  and  fail  to  support 
and  endorse  the  local  boards  of  health. 

People  often  find  it  difficult  to  realize  that  health  matters  are 
in  their  own  hands,  if  they  would  only  act. 


112  DUSTY   AIR   AND   ILL   HEALTH. 

Some  parents  send  their  children  to  school  and  then  leave 
everything  to  the  teacher  or  the  authorities — our  ex-President 
•-•alls  them  li Cuckoo  parents." 

Similarly  we  find  people  who  "leave  everything  to  the  doctor." 
The  physician  ordinarily  discusses  things  medical  only  with  those 
who  come  to  him.  In  the  preparation  of  this  manuscript  I  asked 
the  opinion  of  people  who  do  not  or  only  rarely  come  to  a  phy- 
sician. I  found  some  who  openly  told  me  they  were  not  interested 
in  the  matter  of  ill  health  and  disease  and  causes ;  if  they  did  need 
the  services  of  a  physician  they  expected  to  place  themselves  in 
his  care  and  let  him  do  the  best  possible.  This  at  once  brings  up 
the  question  of  what  is  the  best  possible?  How  can  a  man  know 
unless  he  gives  personal  attention?  How  can  we  know  that  the 
school  authorities  are  doing  the  best  possible  for  the  child  ?  There 
are  any  number  of  details  apt  to  be  overlooked  unless  there  is  per- 
sonal interest. 

Vacuum  Cleaner  Colds.  Kinds  of  colds,  as  here  described, 
are  almost  endless;  every  now7  and  then  one  finds  a  "new  kind." 
At  times  one  may  see  reason  for  some  kind  to  occur  but  it  may  take 
a  long  time  before  an  actual  case  presents  itself.  For  instance, 
within  the  last  few  years  vacuum  cleaners  have  come  into  common 
use.  At  the  one  extreme  are  household  machines  to  which  neither 
sanitarians  nor  physicians  can  find  objection,  while  at  the  other 
extreme  are  those  that  are  highly  objectionable,  with  a  very  coarse 
filter  that  retains  only  the  coarse  particles  and  allows  the  fine  dust 
to  go  through.  In  a  closed  room  the  air  may  be  densely  filled  and 
those  in  it  may  react. 

For  a  long  time  I  had  no  data  on  such  a  kind  of  cold.  My  first 
notes  relate  to  a  poor  woman  with  a  cheap  machine  who  goes  about 
cleaning  houses,  especially  carpets.  Her  health  quickly  declined, 
in  spite  of  the  fact  that  "her  doctor"  had  told  her  the  exercise  of 
using  her  hand-power  machine  would  be  good  for  her.  He  failed 
to  consider  an  important  factor,  one  on  which  I  myself  insist  in 
discussing  ill  health  with  patients. 


COLDS   AND   CATARRH.  113 

X  Colds.  After  patients  have  learned  to  classify  their  colds 
according  to  the  place  where  or  the  conditions  under  which  caught, 
they  at  times  vainly  try  to  account  for  every  attack.  But  at  times 
it  is  almost  impossible  to  trace  the  source.  Then  some  patients 
want  to  discuss  probabilities;  they  often  forget  that  a  physician's 
time  may  be  quite  limited  and  he  may  then  have  no  time  for  dis- 
cussion or  perhaps  no  inclination — the  subject  may  be  old  to  him. 

For  convenience  of  classification  and  explanation  1  have  a  name 
for  colds  whose  origin  can  not  be  traced,  X  Colds,  meaning  a 
cold  of  unknown  origin. 

But  one  must  use  such  an  explanation  sparingly.  It  is  similar 
to  many  in  common  use,  as  the  very  name  "cold."  Is  it  not  true 
that  when  a  patient  is  told  he  has  a  cold  he  ceases  to  make  further 
inquiries,  he  assumes  he  knows,  just  as  he  fails  to  inquire  when 
given  the  "explanation"  dyspepsia  or  nervous  prostration?  Some 
terms  conceal  ignorance.  We  should  inquire  the  why  and  the 
wherefore. 

At  times  the  cause  of  an  X  Cold  may  be  found.  For  instance, 
one  of  my  patients  living  in  the  country  had  acute  attacks  at  times 
when  she  did  not  come  to  town.  The  attacks  were  mysterious  until 
it  was  found  that  she  was  in  the  habit  of  cleaning  dresses  that  had 
been  trailed  over  filthy  sidewalks.  That  is  where  she  got  the  in- 
fection. It  was  no  longer  an  X  Cold.  In  such  a  case  should  one 
apply  a  definite  although  clumsy  name,  Dress  Cleaning  Colds? 

Under  What  Conditions  Does  One  Catch  Colds  ?  In  attempt- 
ing to  answer  such  a  question  one  would  have  to  ask,  Under  what 
conditions  does  one  not  contract  colds?  The  city  men  who  write 
the  books  speak  of  the  importance  of  physical  cold,  of  getting 
chilled,  of  sitting  in  draughts,  or  getting  the  feet  wet,  of  hot,  dry 
air,  of  being  insufficiently  clothed,  and  of  similar  ' '  exciting  causes. ' ' 
The  country  doctor  who  sees  people  who  are  not  constantly  ex- 
posed to  infected  dust  may  find  that  such  an  exposure  may  or  may 
not  be  followed  by  a  cold;  it  depends.  The  farmer  may  expose 
himself  in  all  sorts  of  weather  and  yet  have  no  cold — and  then 

18] 


114  DUSTY    AIR    AND   ILL   HEALTH. 

some  day  he  goes  to  town  and  breathes  a  lot  of  bad  air  and  then 
any  ''exposure"  promptly  brings  on  a  cold. 

According  to  my  own  experience,  I  can  expose  myself  to  all 
the  commonly  accepted  causes  of  colds  without  contracting  a  cold, 
provided  I  have  not  been  exposed  to  infected  dust  for  twenty-four 
or  more  hours.  For  instance,  last  fall  when  the  weather  was  quite 
cool  I  one  day  worked  in  the  garden,  that  is  how  I  get  my  physical 
exercise.  Soon  I  began  to  perspire  and  then  I  drank  a  lot  of  cold 
water  and  that  brought  the  perspiration  profusely  to  the  surface, 
my  shirt  was  wet.  A  rain  storm  came  up  and  I  was  soaked  through. 
Then  while  still  warm  from  the  exertion  1  took  a  cold  bath,  and 
for  a  time  was  exposed  to  a  strong  draught  going  through  the  up- 
stairs rooms ;  I  was  taking  an  air  bath  after  the  fashion  of  Benja- 
min Franklin.  My  supper  was  eaten  rather  hurriedly ;  under  good 
air  conditions  I  am  apt  to  bolt  my  meals.  After  reading  the  even- 
ing papers  for  an  hour  or  so,  I  went  to  bed.  The  next  morning 
I  arose  feeling  fine,  not  the  slightest  evidence  of  a  "cold"  after  all 
this  "exposure." 

In  cold  weather  when  the  temperature  is  below  zero  I  at  times 
go  out  with  very  thin  clothing.  Of  course  I  feel  cold  and  it  feels 
good  to  get  back  into  the  warm  room,  but  there  is  no  after-effect. 
Now  for  the  other  side  of  the  story. 

I  live  on  the  edge  of  town  on  a  four  acre  lot,  under  what  must 
he  considered  good  air  conditions.  For  the  last  year  or  two  I  have 
been  exposed  to  bad  air  only  occasionally,  as  by  going  into  the 
heart  of  the  city  say  for  an  hour  or  two.  On  going  down  I  feel 
perfectly  comfortable  but  when  I  get  back,  after  inhaling  a  lot  of 
infected  dust,  I  have  a  feeling  as  though  not  warmly  enough 
dressed  and  a  similar  feeling  that  the  house  is  not  sufficiently 
heated,  and  then  if  I  am  not  "careful,"  that  is  in  avoiding  the 
commonly  accepted  causes  of  colds,  as  those  just  mentioned,  I  am 
apt  to  have  a  cold,  perhaps  a  "bad  cold." 

I  have  numerous  notes  relating  to  conditions  under  which  I  do 
or  may  contract  a  cold  and  under  what  conditions  I  am  apt  to  es- 


COLDS   AND    CATARRH.  115 

cape,  and  yet  I  do  not  claim  to  know  all  about  colds.  Being  sub- 
ject to  colds  but  not  to  attacks  of  dyspepsia  or  of  "nervous  pros- 
tration," I  can  not  speak  about  these  latter.  I  did  however  have 
one  dyspeptic  attack  in  the  fall  of  1908  when  returning  from  the 
International  Congress  on  Tuberculosis,  at  Washington.  I  was  in 
a  Pullman  sleeper  with  every  berth  taken.  Evidences  of  a  de- 
ranged stomach  promptly  appeared  and  did  not  fully  disappear 
for  two  or  three  weeks.  Had  I  been  more  susceptible  I  might 
earlier  have  understood  patients  who  complained  of  dyspepsia,  but 
on  the  other  hand  had  I  been  more  susceptible  likely  I  would  not 
have  passed  through  medical  school  at  all  and  would  not  now  be 
writing  as  a  physician. 

I  have  a  number  of  notes  on  patients  and  from  friends  who 
have  been  experimenting  to  find  out  under  what  conditions  they 
contract  colds.  A  professional  man  who  is  fond  of  hunting  had 
noticed  that  it  makes  a  difference  how  he  goes  to  the  hunting 
grounds,  whether  he  walks  out  or  goes  in  a  buggy  or  automobile 
or  goes  by  train.  If  the  latter  he  must  be  very  careful  not  to  get 
chilled  or  break  through  the  ice,  because  then  he  is  sure  to  con- 
tract a  cold,  while  if  he  did  not  inhale  infected  air  he  will  prob- 
ably escape  a  cold. 

Another  professional  man  who  takes  an  occasional  hunting  and 
fishing  trip  to  the  north  has  learned  that  while  in  the  wilderness 
he  can  do  almost  anything,  expose  himself  in  every  way,  indeed 
eat  all  sorts  of  food,  without  having  a  dyspeptic  attack  or  com- 
plaining of  symptoms  of  dyspepsia.  What  would  be  a  "throat 
cold"  in  others  in  him  manifests  itself  as  a  "stomach  cold,"  per- 
haps a  derangement  of  the  entire  alimentary  tract. 

Perhaps  in  the  light  of  such  facts  the  reason  north  pole  ex- 
plorers escape  not  only  colds  but  all  sorts  of  acute  disturbances 
is  not  difficult  to  understand,  nor  why  weather  observers  on  high 
mountains  should  complain  on  coming  down  and  mixing  with  peo- 
ple. That  colds  are  contagious  is  a  fact  well  recognized  by  my 
old  patients. 


116  DUSTY   AIR   AND  ILL   HEALTH. 

Overheated  Rooms.  A  young  woman  living  in  a  thinly  set- 
tled part  of  the  city,  one  of  my  recent  patients  not  fully  informed 
regarding  dust  influences,  was  talking  with  one  of  my  old  patients. 

"Why  is  it,"  she  was  asking,  "that  my  father  when  he  comes 
home  wants  the  house  overheated,  while  my  mother  and  I  are  per- 
fectly comfortable  with  a  much  lower  temperature?  And  that  is 
the  way  with  Mr.  —  (a  neighbor)  ;  the  moment  he  gets  home  he 
wants  the  house  overheated.  And  there  is  Dr.  X ;  he  is  never  warm 
at  home.  It  seems  the  doctors  all  have  their  offices  overheated 
and  yet  they  speak  of  the  evils  of  close,  overheated  rooms." 

My  old  patient  mentioned  that  her  doctor  (myself)  does  not 
have  his  office  overheated.  The  new  patient  suddenly  saw  a  light. 
"Oh,  he  does  not  go  down  town."  The  subsequent  conversation 
developed  that  she  saw  that  when  men  are  constantly  exposed  to 
infection  down  town  they  want  the  rooms  overheated  while  those 
living  under  good  air  conditions  all  the  time  are  comfortable  under 
a  much  lower  temperature. 

But  this  patient  could  not  understand  the  case  of  two  sisters, 
one  of  whom  was  at  home  most  of  the  time  and  always  wanted  the 
house  overheated,  while  the  other  sister  who  was  down  town  all 
day,  much  exposed  to  bad  air,  wanted  more  ventilation  the  moment 
she  came  home;  she  did  not  complain  of  a  low  temperature.  How 
is  that  to  be  explained  ?  The  reason  is  not  far  to  seek :  The  one 
sister  is  a  marked  dust  victim;  the  other  is  an  immune  (at  least 
as  far  as  known,  perhaps  she  does  react,  symptoms  may  appear 
later) . 

Varying  Manifestations  of  Colds.  The  term  "cold"  as  used 
in  this  volume  and  as  already  mentioned  is  synonymous  with  Dust 
Infection.  Individuals  react  differently  and  indeed  an  individual 
may  be  differently  attacked.  An  attack  may  be  so  slight  that  there 
is  a  mere  sense  of  discomfort,  a  feeling  of  malaise  or  feeling  achy ; 
there  may  be  even  a  chilly  sensation.  With  additional  exposure 
decided  evidences  of  a  cold  may  appear.  There  may  be  a  disturb- 
ance in  the  respiratory  tract  or  in  the  alimentary  tract  or  else- 
where. 


COLDS    AND    CATARRH.  117 

"Caught  more  cold"  commonly  means  more  exposure  to  bad 
air.  At  times  colds  seem  to  be  epidemic,  especially  in  the  early 
part  of  the  new  year.  Locally  the  usual  explanation  is  this :  Snow 
and  ice  on  streets  and  sidewalks  hold  down  infection;  the  snow 
and  ice  may  be  discolored  by  a  large  amount  of  tobacco  juice,  not 
to  mention  soot  that  comes  from  burning  soft  coal.  Street  clean- 
ing stops  when  there  is  ice  and  snow  and  then  comes  a  thaw  and 
the  accumulated  filth  is  liquified  and  tracked  indoors  where  it  be- 
comes dry  and  is  pulverized  under  foot  and  arises  as  infected  dust. 
A  few  days  of  thaw  may  dry  out  the  filth  on  streets  and  sidewalks 
and  then  it  is  blown  about  and  practically  everybody  may  complain. 
That  is  the  time  when  the  doctors  are  busy  day  and  night.  On 
the  other  hand  if  the  accumulation  goes  out  suddenly  with  a  warm 
rain  the  "expected  epidemic"  fails  to  materialize. 

To  show  how  dust  infection  affects  different  members  of  the 
family  I  shall  briefly  mention  a  few  family  histories. 

FAMILY  HISTORIES. 

Several  years  ago  a  high  school  student  came  to  me  complain- 
ing greatly  of  ill  health,  she  was  on  the  point  of  breaking  down. 
T  knew  the  air  and  dust  conditions  of  that  school  and  promptly 
told  her  what  I  thought  was  at  the  bottom  of  her  difficulties.  On 
getting  her  family  history  I  found  that  her  father  was  much  ex- 
posed to  infected  dust  and  was  constantly  complaining  of  colds 
and  catarrh.  That  meant  he  brought  home  infection ;  that  in  turn 
meant  she  was  getting  bad  air  at  school  and  at  home.  Her  mother 
was  apparently  an  immune;  she  never  complained.  Her  eldest 
sister  was  also  an  immune,  could  go  everywhere  and  anywhere. 
(She  recently  removed  to  a  large  city  and  now  complains  of 
"rheumatism.")  Her  second  sister  was  very  susceptible;  could 
not  go  anywhere  without  becoming  ill  and  complained  greatly 
during  the  closed  door  season  at  home  on  account  of  infection 
brought  by  her  father.  When  she  took  vacations  in  a  clean  com- 
munity she  got  along  very  well  but  suffered  coming  and  going  on 
account  of  air  of  railway  coaches.     Her  susceptibility  to  colds 


118  DUSTY    AIR    AND    ILL    HEALTH. 

reminds  one  of  the  remark  of  Robert  Louis  Stevenson.  He  re- 
quested people  with  colds  to  stay  away  from  him  as  far  as  pos- 
sible, because  otherwise  he  was  sure  to  catch  a  cold. 

My  patient  apparently  was  not  as  susceptible  as  the  last  men- 
tioned sister.  Had  she  been  she  would  not  have  been  in  high 
school.  I  explained  that  likely  she  would  continue  to  suffer  more 
or  less  until  she  finished  high  school  and  that  her  future  health 
would  depend  upon  her  environment,  whether  she  lived  under 
good  or  bad  air  conditions.  It  was  interesting  to  follow  develop- 
ments. She  managed  to  complete  the  high  school  course  and  then 
went  to  a  college  where  air  conditions  are  good  and  there  had 
good  health.  Although  she  "studied  harder  than  ever,"  she 
showed  no  signs  of  being  "overworked."  Then  she  taught  in  the 
local  schools  for  a  year  and  was  complaining  more  or  less  con- 
stantly, her  complaints  being  traceable  to  air  conditions.  At  one 
time  there  was  an  acute  inflammatory  process.  Then  she  obtained 
a  position  in  a  suburban  school  near  a  large  city.  Here  every- 
thing is  neat  and  clean,  especial  attention  is  paid  to  cleanliness 
and  to  ventilation.  She  now  has  the  best  of  health,  never  com- 
plains. I  may  add  that  I  now  and  then  prescribe  for  every  mem- 
ber of  that  family.  Such  a  family  history  clearly  shows  the  in- 
fluence of  environment. 

People  who  have  drifted  about  among  physicians  and  are  still 
"uncured"  as  a  rule  have  a  poor  opinion  of  "medical  science." 
When  their  susceptibility  and  the  nature  of  their  ill  health  is 
properly  explained  to  them,  and  when  they  see  explanations  veri- 
fied, they  get  a  better  opinion  of  the  art  or  science  of  Medicine. 

Unfortunately  few  physicians  make  any  detailed  inquiry  into 
family  histories.  I  failed  to  do  so  myself  at  first.  I  recall  the  case 
of  a  middle-aged  woman  who  when  asked  if  she  had  a  family  re- 
plied, Yes,  a  husband  and  two  children.  Are  they  strong  and 
healthy?  Yes,  the  boys  are  thoroughly  healthy  but  my  husband 
complains  some  of  catarrh.  I  inquired  no  further  and  on  my  notes 
entered,  "Family  history  negative,"  a  standard  phrase  in  medical 
case  reports.     Some  time  later  when  we  were  well  acquainted  and 


COLDS    AND    CATARRH.  119 

when  I  was  after  details  I  learned  that  she  had  lost  five  children 
in  infancy.  In  the  light  of  such  a  history  it  is  no  wonder  that 
the  two  remaining  ones  are  "thoroughly  healthy."  The  weak  ones 
died  off. 

We  sometimes  hear  the  Scotch  spoken  of  as  a  "hardy  race." 
Adam  Smith  tells  that  of  a  large  number  of  children  born  to 
Scotch  families  only  one  or  two  reach  maturity.  Perhaps  that 
explains  it.  Those  who  advocate  large  families  may  or  may  not 
know  about  this  weeding  out  factor.  In  large  families  children 
receive  less  attention  than  where  there  are  only  one  or  two.  But 
there  may  not  be  the  survival  of  the  best.  There  is  an  old  saying, 
The  good  die  young.  As  matters  stand  now  the  "survival  of  the 
fittest"  means  the  survival  of  those  best  adapted  to  live  under 
unsanitary  surroundings.  If  conditions  were  improved  many  more 
would  survive. 

Several  years  ago  while  visiting  in  a  large  and  dirty  city  I 
accompanied  a  friend  to  the  home  of  one  of  his  friends  and  was 
asked  to  stay  for  dinner.  Besides  the  father  and  mother  there 
were  a  boy  of  about  eight  years  and  a  girl  who  had  just  reached 
school  age.  All  the  family  "looked  healthy,"  a  fact  to  which  my 
friend  directed  my  attention  as  an  argument  against  my  idea  that 
a  dirty  city  is  an  unsanitary  city.  I  suspected  that  at  the  first 
opportunity  he  would  bring  up  the  subject  for  discussion.  Now 
when  a  doctor  visits  people  naturally  there  is  a  tendency  to  direct 
the  conversation  along  the  line  of  things  medical.  Some  do  it  to 
get  free  medical  advice,  others  "to  make  talk."  "We  all  know  how 
readily  the  doctor  will  talk  shop.  He  may  talk  entertainingly 
when  otherwise  he  would  be  dull.  There  was  no  difficulty  in  get- 
ting data,  A  few  properly  directed  questions  led  me  to  arrive  at 
some  conclusions  regarding  the  remark  of  my  friend  that  all  the 
family  looked  healthy.  Here  are  some  data  on  which  to  base  con- 
clusions : 

The  father's  family  was  country  bred  and  healthy.  He  came 
to  the  city  years  ago  and  city  life  agreed  with  him.  Two  of  his 
brothers  also  tried  city  life  but  had  to  return  to  the  country.    The 


320  DUSTY    AIR    AND    ILL    HEALTH. 

mother  was  city  born  and  so  were  her  parents.  She  has  "robust 
health."  She  belongs  to  the  apoplectic  type  and  one  feels  like 
predicting  premature  death  from  cardio-vascular  disturbance.  The 
first  two  children  died  in  infancy.  Then  came  the  two  living 
children.  The  boy  is  healthy, ''only  he  gets  very  nervous  at 
times."  A  little  questioning  led  me  to  assume  that  he  reacts  when 
conditions  are  very  bad.  The  girl  is  just  reaching  school  age  and 
the  effects  of  school  air  are  to  be  determined.  Then  came  another 
child  that  also  died  in  youth. 

Here  then  we  have  a  father  who  is  adapted  to  city  life;  a 
mother  who  is  adapted ;  two  children  who  are  the  survivors  out 
of  five.  Had  the  father  been  susceptible  he  would  not  have  re- 
mained in  the  city;  he  would  have  gone  back  to  the  country  with 
his  brothers.  Had  the  mother  not  been  adapted  she  likely  would 
have  perished  long  ago.  From  such  a  parentage  one  may  expect 
children  more  or  less  adapted  to  city  conditions.  And  where  three 
out  of  five  fail  one  may  look  for  "healthy  looking  children."  It 
would  be  interesting  to  know  the  subsequent  fate  of  such  a  family. 

In  this  connection  I  recall  another  family  history,  three  grown 
brothers  and  two  sisters.  One  of  the  brothers  came  to  me  ten 
years  ago,  complaining  of  continued  ill  health,  saying  he  and  a 
sister  had  more  than  their  share,  that  they  more  than  made  up 
the  family  average,  the  three  others  practically  never  complain- 
ing. Today  these  two  sickly  ones  are  still  living.  The  sister  who 
never  complained  died  suddenly  of  pneumonia  and  one  of  the 
brothers  may  at  any  moment  die  of  apoplexy.  My  patient  is  pru- 
dent and  in  spite  of  his  more  or  less  complaining  is  likely  to  live 
on  to  old  age. 

Environment  and  heredity  are  closely  bound  up.  It  may  be  all 
but  impossible  to  determine  where  the  one  begins  and  the  other 
ends.  Every  now  and  then  we  meet  people  where  one  or  the 
other  is  very  susceptible,  having  constant  ill  health,  the  other 
being  immune.  Of  the  children  some  are  susceptible.  Thus  in 
the  case  of  the  —  family,  country  people  living  in  isolation,  men- 
tioned later  on,  the  father  is  immune  to  dust  influences,  the  mother 


COLDS   AND   CATARRH.  121 

very  susceptible.  The  two  oldest,  boys,  follow  their  mother,  like- 
wise the  youngest,  a  girl,  two  daughters  being  immunes. 

Out  of  the  family  histories  I  will  quote  that  of  —  family.  It 
is  an  average  prosperous  family,  dependent  on  daily  labor. 

This  family  was  with  me  for  a  number  of  years.  The  children 
are  given  in  order  of  their  ages ;  there  is  an  interval  of  about  two 
years  between  each;  the  youngest  has  just  arrived  at  maturity; 
all  are  unmarried. 

Father :  has  an  occupation  that  keeps  him  out  of  doors  most  of 
the  time;  is  never  ill  and  never  complains  of  an  ache  nor  a  pain. 

Mother:  has  been  subject  to  colds  and  sore  throat  all  her  life; 
throat  full  of  scar  tissue;  mucus  forms  readily  on  exposure  to 
dusty  air;  rheumatic  and  neuralgic  pains  frequent,  at  times  one 
can  diagnose  fibromyositis  and  again  neuritis;  had  an  attack  of 
pneumonia  recently,  recovered  promptly  in  good  air ;  is  a  i '  chronic 
neurastheniac."  Ill  health  is  very  largely  dependent  on  air  con- 
ditions.    Her  parents  were  farmers  and  susceptible  to  bad  air. 

Daughter:  has  an  indoor  occupation  with  fair  air  conditions; 
has  frequent  colds  and  an  irritable  throat,  but  looks  the  picture 
of  health. 

Daughter :  indoor  occupation  with  poor  air  conditions ;  belongs 
to  the  rheumatic  type  of  dust  infection  and  complains  more  or 
less  constantly;  aches  severely  all  over  after  an  exposure  to  un- 
usually bad  air. 

Son:  indoor  occupation  under  bad  air  conditions;  has  always 
been  subject  to  colds  and  coughs  and  had  two  attacks  of  "lung 
fever"  as  a  child;  has  tried  a  number  of  occupations  since  leaving 
school  but  has  not  yet  found  the  right  one,  the  one  compatible 
with  "good  health."  He  is  the  only  member  of  the  family  who 
under-estimates  dust  influences — and  suffers  proportionately. 

Daughter :  exposure  to  bad  air  means  dysmenorrhea,  with  more 
or  less  aching  along  the  spinal  column.  She  remains  at  home,  goes 
out  but  little. 

To  make  such  a  family  history  of  greater  value  one  should  in- 
quire further  back  regarding  the  grandparents  and  greatgrandpar- 


122  DUSTY    AIR    AND    ILL    HEALTH. 

ents,  in  fact  back  as  far  as  possible  although  we  should  keep  in  mind 
that  the  further  back  we  go  the  less  reliable  data  become  as  well  as 
causes  from  which  people  died.  This  is  especially  true  in  new 
countries  where  physicians  are  few  and  where  the  methods  of 
diagnosing  are  of  the  rough  and  ready  sort,  where  people  die  of 
"'lung  trouble"  and  stomach  trouble,"  terms  that  may  include  all 
kinds  of  diseases  and  causes  of  death.  The  place  where  the  an- 
cestors lived  is  important.  People  who  have  always  lived  in  the 
country  may  be  healthy  simply  because  not  exposed  to  the  causes 
of  disease.  People  on  the  other  hand  may  be  healthy  because  they 
are  the  survival  of  the  fittest.  We  trace  our  ancestry  to  Europe : 
Under  what  conditions  did  our  forefathers  live?  To  what  ex- 
tent wras  there  a  weeding  out?  The  descendants  of  people  long 
accustomed  to  city  conditions  are  more  apt  to  thrive  under  city 
life  than  those  whose  ancestors  have  always  lived  under  rural  con- 
ditions. The  robust  country  man  coming  to  the  city  may  not  last 
long,  while  the  anemic  city  man  lives  on  and  on.  The  Jew  who 
traces  his  ancestry  to  some  European  ghetto  may  be  able  to  live 
under  city  conditions  here  where  another  whose  ancestors  have 
been  country  people,  as  most  of  the  European  Jews  coming  to  our 
country  now,  may  utterly  fail.  In  a  larger  sense,  these  remarks 
apply  to  the  prevalence  of  diseases,  as  for  instance  to  the  immunity 
of  the  West  Coast  negro  to  malaria,  the  susceptible  have  been  and 
are  constantly  being  killed  off.  Our  own  people  would  become 
similarly  immune  if  long  enough  exposed,  but  naturally  at  a  great 
loss  of  life. 

In  discussing  the  influence  of  an  unsanitary  environment  on 
offspring  one  should  also  mention  the  reverse.  I  have  several  his- 
tories of  individuals  who  many  years  ago  were  brought  from  large 
eastern  cities  as  foundlings  or  "refugees."  Some  at  least  were 
children  that  come  under  the  head  of  "gutter-snipes,"  they  were 
ill-formed,  prematurely  old,  and  showed  the  scars  of  conflicts  with 
unsanitary  city  conditions.  Such  individuals  are  usually  adopted 
by  childless  couples,  at  times  by  families  wnth  many  children,  and 
the  contrast  between  "strong  and  healthy  country  children"  and 


COLDS    AND    CATARRH.  123 

the  "weak  and  sickly  city  child"  may  be  very  marked.  In  time 
the  child  grows  into  a  man,  the  man  marries — and  in  his  children 
Nature  reasserts  herself,  his  children  as  a  rule  are  "strong  and 
healthy." 

Shall  we  say  that  man  like  animals  and  plants  reverts  to  the 
aboriginal  state  if  "left  to  nature,"  if  freed  from  artificial  condi- 
tions and  restraints  to  which  man  subjects  himself,  his  children, 
his  animals  and  plants? 

Shall  we  go  a  step  further  and  say  that  "strong  and  healthy" 
means  such  only  under  good  surroundings  and  that  the  strong  and 
healthy  fail  on  going  into  an  unsanitary  environment? 

Civilization  means  cleaning  up.  We  differ  from  savages  in 
that  we  do  not  tolerate  lousiness  and  filthiness,  we  bathe  frequently 
and  wear  clean  clothing,  we  have  clean  homes  and  clean  cities. 
To  understand  this  fully  we  must  read  about  former  days.  Shall 
we  say  that  in  proportion  as  cities  do  not  clean  up  they  do  not 
represent  the  civilization  of  today? 

In  whatever  manner  we  follow  up  the  subject  the  need  for 
cleaning  up  crops  out. 

DUST  INFECTION  AND  AGE. 

When  one  studies  many  dust  victims,  covering  a  large  number 
of  years,  one  feels  inclined  to  divide  them  into  groups  about  as 
follows : 

The  New  Born.  We  all  know  that  it  is  impossible  for  every 
child  to  live;  some  die  at  once,  some  lead  a  precarious  existence 
for  days  or  weeks  or  months  and  then  perish.  Children  living 
under  sanitary  conditions  and  having  the  best  of  care  naturally 
stand  the  best  chance  of  surviving,  but  we  should  not  forget  that 
such  children  may  be  "delicate,"  they  readily  react  to  unsanitary 
surroundings  and  may  develop  into  "chronics." 

The  second  period  may  be  said  to  begin  with  school  life,  that 
means  coming  in  contact  with  others  under  more  or  less  unsanitary 
surroundings.  The  air  of  schools  as  a  weeding  out  factor  of 
course  varies  greatly.     Some  schools  are  very  unsanitary,  in  none 


124  DUSTT    AIR    AND   ILL    HEALTH. 

is  the  ventilation  perfect.  The  child  from  a  clean  suburban  home 
en  attending  the  school  half  way  to  the  heart  of  the  city  may  find 
conditions  very  bad;  there  may  be  constant  colds  and  ill  health 
of  all  kinds,  not  to  speak  of  contracting  the  specific  diseases  of 
childhood.  On  the  other  hand  the  child  from  the  heart  of  the 
city,  living  under  bad  air  conditions  at  home,  may  find  that  same 
school  sanitary,  that  is  comparatively  speaking.  We  thus  have  a 
paradox:  children  of  some  parents  are  sent  to  an  "unsanitary 
school"  -while  children  of  others,  those  from  the  heart  of  the  city, 
are  sent  to  a  "sanitary  school."  The  slum  child  may  actually 
have  better  health  while  going  to  the  school  half  way  out  to  the 
suburbs  or  edge  of  town. 

Third,  a  period  beginning  with  the  close  of  the  graded  school 
period.  Here  we  must  divide  individuals  into  two  subgroups,  those 
who  continue  their  schooling  and  those  who  get  into  some  gainful 
employment,  including  the  girl  who  stays  at  home  and  docs  house- 
work. The  boy  or  girl  who  has  been  going  to  a  comparatively 
sanitary  graded  school  now  goes  to  the  unsanitary  high  school  lo- 
cated in  the  heart  of  the  city  where  air  conditions  are  very  bad. 
There  may  now  be  so  much  ill  health  that  the  student  drops  out. 
Those  who  pass  through  an  unsanitary  high  school  may  be  con- 
sidered the  survival  of  the  fittest,  meaning  that  they  are  able  to 
thrive  or  at  least  exist  under  unsanitary  conditions.  When  they  go 
to  college,  especially  to  one  where  some  attention  is  given  to  air 
conditions,  they  may  have  no  difficulties  at  all.  They  may  even 
survive  the  air  conditions  found  in  professional  schools  in  the 
very  heart  of  large  cities. 

Fourth,  the  period  when  an  individual  begins  an  independent 
existence  by  taking  up  some  occupation.  Whether  an  individual 
leads  the  life  of  a  farmer  or  market  gardener  or  whether  he  leads 
the  life  of  a  clerk  down  town  or  as  a  mechanic  in  some  factory 
may  make  a  marked  difference  in  his  future  life.  It  is  the  ex- 
ceptional man  who  becomes  an  employer  instead  of  being  the  em- 
ployed. The  industrial  city  is  constantly  calling  for  strong  men 
but  it  may  be  only  a  few  years  until  it  has  "taken  it  out"  of  them 


COLDS   AND   CATARRH.  125 

and  has  no  further  use  for  them.  Unfortunately  we  have  no  re- 
liable statistics  regarding  the  longevity  of  men  in  different  trades 
and  professions  in  our  country.  People  are  not  born  to  trades  and 
professions  as  they  are  in  the  old  world ;  foreign  statistics  can  not 
properly  be  applied. 

Fifth,  the  decline  of  life,  when  an  individual  begins  to  realise 
his  limitations,  that  he  can  no  longer  do  as  in  youthful  years. 
Many  have  chronic  ill  health,  others  frequent  acute  attacks.  When 
we  critically  study  symptoms  we  often  find  that  attacks  are  con- 
servative processes,  just  as  symptoms  are  warnings  from  nature. 
The  city  man  who  has  constant  ill  health  may  have  a  return  of 
good  health  on  going  to  the  country. 

Sixth,  finally  we  may  consider  people  who  have  attained  the 
proverbial  three  score  and  ten.  It  is  interesting  to  study  the  lives 
of  old  people,  the  conditions  under  which  they  live  and  have  lived, 
and  whether  they  have  or  have  had  much  or  little  ill  health  or 
sickness.  In  thinly  settled  communities  many  may  reach  old  age, 
while  in  crowded  cities  it  is  the  exceptional  individual  who  at- 
tains it.  With  infection  all  about  it  is  a  wonder  that  a  city  man 
reaches  old  age  at  all.  Golden  weddings  are  rather  frequent  in 
the  country.  One  of  my  friends  has  a  belief  that  a  fatality  soon 
follows  a  celebration.  Perhaps  it  is  due  to  the  fact  that  the  quiet 
of  the  home  is  disturbed  by  a  large  crowd,  some  of  whom  bring 
infection. 

TIME  LOST  ON  ACCOUNT  OF  ILL  HEALTH. 

The  amount  of  time  lost  on  account  of  ill  health  and  disease 
is  an  interesting  question.  Some  individuals  lose  much  time, 
others  little,  A  headache  may  disable  a  brain  worker,  a  backache 
a  laborer.  Slight  pains  and  aches  may  be  neglected,  severe  pains 
call  for  rest  from  work.  Some  persons  are  disabled  from  a  slight 
ailment,  others,  especially  poor  people,  keep  on  working  even  when 
seriously  diseased. 

Acute  specific  diseases  may  appear  suddenly,  but  chronic  dis- 
eases as  a  rule  appear  only  after  repeated  premonitions.    The  abil- 


12G  DUSTY    AIR    AND    ILL    HEALTH. 

ity  to  take  a  timely  day  or  a  week  off  may  mean  to  escape  serious 
ill  health  and  disease,  as  well  as  chronic  ill  health.  To  some  Sun- 
day as  a  day  of  rest  means  much.  The  subject  is  especially  in- 
teresting- from  the  standpoint  of  dust. 

I  have  already  referred  to  a  patient  (p.  93)  who  soon  recog- 
nized the  value  of  a  vacation,  a  day  or  a  week  or  even  several 
weeks  off,  and  now  avoids  much  ill  health.  Here  is  a  patient,  one 
of  several  similar  ones,  who  was  sent  me  by  a  physician  as  a 
"peculiar  case"  which  he  wanted  me  to  "work  out." 

I  found  the  man  to  be  a  dust  victim  "with  a  stomach."  He 
promptly  improved  by  following  good  air  advice,  plus  taking  a 
little  medicine,  and  then  was  ready  to  go  to  work.  I  advised 
against  this,  telling  him  to  get  himself  in  good  shape  first  or  he 
would  relapse.  A  few  weeks  made  a  wonderful  difference  in  his 
appearance.  Then  a  brother  who  has  a  poolroom1  became  ill  and 
another  brother  took  his  place ;  the  latter  however  began  to  ' '  give 
out"  in  the  course  of  two  or  three  weeks,  and  then  my  patient 
thought  it  his  duty  to  relieve  him,  for  an  hour  or  two  at  meal 
times  at  least.  I  advised  against  this  also  but  he  thought  it  was 
his  duty.  He  remained  for  less  than  a  week  when  he  ' '  was  all  in. ' ' 
He  was  now  glad  enough  to  remain  under  good  air  conditions, 
chiefly  by  going  out  along  the  river,  fishing.  About  two  weeks  later 
the  substituting  brother  was  again  on  the  point  of  breaking  down, 
and  my  patient  again  went  to  the  rescue,  daily  remaining  a  short 
time,  at  meal  hours.  I  questioned  him  closely.  It  was  inter- 
esting to  find  how  in  proportion  as  he  was  exposed  to  bad  air  con- 
ditions he  felt  bad,  while  his  brother,  by  being  out  under  good 
air  conditions  for  a  few  hours  every  day,  improved.  Neither  of 
these  two  men  is  adapted  to  indoor-bad-air  life  conditions.  As 
a  matter  of  fact,  the  other  brother,  the  poolroom  owner,  himself  is 
not  adapted  but  has  simply  continued,  not  knowing  what  else  to 
do.  If  my  patient  discusses  these  matters  freely  with  his  brothers 
it  is  likely  that  all  may  adopt  the  pure  air  advice.  I  am  curious 
to  see  how  these  three  cases,  one  of  whom  is  my  patient,  will  ulti- 
mately work  out. 

1  On  the  window  is  painted  "Shine  and  Cigars."    That  means  that  the  room  is  filled  both  with 
dust  and  smoke. 


COLDS   AND    CATARRH.  127 


CLIMATE. 


If  people  can  not  otherwise  account  for  their  ills  they  will 
ascribe  them  to  the  climate  or  accuse  the  climate. 

Man  is  peculiar  in  that  his  kind  is  found  everywhere,  from 
pole  to  pole.  At  the  same  time  we  must  consider  that  there  ar<i 
different  races  or  strains  of  man,  some  adapted  to  one  region, 
some  to  another.  If  the  Eskimo  from  the  far  north  and  the  tropi- 
cal South  Sea  Islander  exchanged  places  both  would  likely 
promptly  perish. 

People  of  the  temperate  zone  with  half  a  year  of  summer  and 
half  of  winter  bear  such  changes  quite  well — they  become  adapted 
to  variations.  But  if  the  change  is  too  great  they  may  not  nourish, 
as  our  people  among  the  Eskimos  or  in  the  hot  moist  tropics.  The 
term  climate  of  course  includes  many  things  besides  changes  in 
temperature — food,   clothing,  housing  must  be  considered. 

When  we  ordinarly  speak  of  "change  of  climate"  we  have  no 
radical  change  in  mind.  As  a  rule  people  move  along  lines  of 
latitude  rather  than  longitude.  It  is  the  exceptional  man  who 
goes  to  the  tropics  and  returns  home  with  some  tropical  disease, 
or  returns  from  the  far  north  with  feet  or  hands  or  ears  frozen 
off. 

Our  people,  my  folks  and  your  folks,  are  accustomed  to  the 
alternation  of  a  warm  and  cold  country,  half  the  year  we  have 
winter  weather  and  half  the  year  summer.  We  are  used  to  this. 
The  very  young  and  the  very  old  may  react  acutely,  may  even 
perish,  but  ordinarily  we  do  not  look  for  such  effects  nor  do  we 
expect  ill  health  or  disease  on  account  of  the  annual  changes — 
barring  such  affections  as,  for  instance,  hay-fever  and  sunstroke 
in  summer,  chilblains  and  frozen  ears  in  winter,  not  to  speak  of 
freezing  to  death. 

We  constantly  make  efforts  to  counteract  disagreeable  effects 
— dress  warmly  in  winter  and  live  in  warm  houses,  or  keep  cool 
and  in  the  shade  in  summer.  Yet  many  take  few  precautions  at 
all  and  still  are  healthy  and  live  on  to  old  age. 

But  people  in  ill  health  or  diseased  may  be  acutely  sensitive 


128  DUSTY    AIR    AND   ILL    HEALTH. 

to  annual  changes,  they  complain  of  the  heat  of  summer  and  the 
cold  of  winter,  but  that  these  annual  changes  are  productive  of  ill 
health  and  disease  is  another  question.  People  who  do  complain 
of  weather  and  seasonal  changes  likely  have  something  the  matter 
with  them  due  to  causes  other  than  climate. 

When  we  critically  consider  causes  of  ill  health  we  may  con- 
clude that  climate  by  itself  has  little  influence  in  producing  ill 
health,  not  to  speak  of  disease.  We  must  consider  that  man  is 
constantly  interfering  with  nature,  that  he  is  altering  the  condi- 
tions under  which  he  lives.  For  one  thing  he  creates  an  indoor 
climate  for  himself,  just  as  he  does  for  his  house  plants.  Many 
ills  are  traceable  to  an  "indoor  climate"  and  that  means  especially 
to  conditions  found  in  homes,  in  public  places  of  all  kinds,  stores, 
shops,  factories,  offices,  churches,  theaters,  schools.  Indeed  the 
very  air  out  of  doors  is  modified,  filled  with  smoke  and  dust,  ob- 
scuring the  life-giving  sunlight. 

Climatic  influences,  weather  influences  and  dusty  air  influences 
are  usually  intimately  bound  up.  The  man  who  has  ill  health  and 
"changes  climate"  by  going  say  to  southern  California  and  clerk- 
ing in  a  store  in  the  heart  of  a  large  city,  perhaps  living  close  by, 
is  not  at  all  getting  the  "benefit  of  the  climate."  The  real  climate 
is  out  of  doors  and  away  from  the  city.  The  invalid  who  goes 
south  on  the  approach  of  cold  weather  does  so  mainly  to  escape 
northern  indoor  life ;  in  proportion  as  he  lives  in  hotels  or  health 
resorts  indoors  he  misses  the  climatic  influence.  When  a  physician 
has  seen  many  such  cases  he  may  have  some  decided  views  which 
he  will  impart  to  patients  who  think  of  changing  climate. 

The  hay-fever  victim  who  ' '  changes  climate ' '  in  reality  escapes 
his  usual  affliction  by  going  to  a  place  where  the  cause  of  his  ill 
health  or  disease  (the  pollen  of  certain  plants)  is  absent.  It  may 
not  be  a  matter  of  climate  at  all.  Some  plants  depend  on  climatic 
conditions,  others  on  conditions  made  by  man  himself.  The  Rag- 
weed does  not  grow  in  shaded  forests  nor  in  undrained,  wet  places. 
Making  the  soil  arable  usually  means  to  make  it  favorable  also  for 
the  growth  of  the  Ragweed  and  for  weeds  in  general.    Pollen  dust 


COLDS   AND   CATARRH.  129 

as  a  cause  of  ill  health  should  he  differentiated  from  "climate"  as 
a  cause  of  ill  health.  Different  kinds  of  pollen  produce  different 
kinds  of  ' '  colds ' '  or  ' '  catarrh. ' ' 

Physicians  are  constantly  sending  patients  "to  a  different 
climate."  But  they  do  not  send  healthy  people,  there  must  be 
"something  the  matter."  It  is  the  strong  and  healthy  who  go  to 
a  new  country  to  settle;  they  leave  the  sick  and  diseased,  the 
feeble  and  decrepit,  behind — at  least  that  was  true  before  the  days 
of  easy  travelling  facilities.  The  new  settlers  are  healthy;  it  is 
only  gradually  that  the  old  diseases  of  civilization  come  in. 

It  is  not  likely  that  the  home  climate  produces  the  ill  health 
and  it  is  not  likely  that  a  change  of  climate  pure  and  simple  will 
cure,  although  such  a  change  may  produce  a  marked  effect,  per- 
haps less  due  to  climate  itself,  however,  than  change  of  life  and 
surroundings,  habits,  rest,  food,  water,  etc.,  all  must  be  considered. 
Many,  like  the  Knight  of  the  Holy  Grail,  seek  in  a  distant  country 
for  that  which  they  will  likely  find  near  at  home.  Dust-free-air 
is  advertised  by  German  sanatoria.  But  there  is  no  need  for  the 
dust  victim  to  go  to  Germany;  he  can  have  dust-free  air  near  at 
home. 

Formerly  on  account  of  limited  travelling  facilities  it  was  dif- 
ficult for  a  physician  to  determine  whether  a  patient,  ill  from  any 
one  or  more  of  many  causes,  was  influenced  by  climate  or  not,  but 
today  he  may  arrive  at  definite  conclusions.  Some  physicians  are 
constantly  sending  patients  away.  In  reading  English  biographies 
one  constantly  finds  references  to  London  physicians  sending  their 
patients  away.  Some  are  sent  south  on  the  approach  of  cold 
weather  and  north  on  the  return  of  warm  weather.  Some  people 
try  all  sorts  of  climates,  seashore,  plain  and  mountain,  not  to  speak 
of  hot  and  cold  climates. 

A  physician  is  constantly  meeting  patients  where  the  matter  of 
climate  comes  up,  as  in  the  following  case.  A  young  housewife 
who  had  always  lived  in  this  locality  complained  more  or  less  of 
general  ill  health  and  every  now  and  then  of  sharp  pains,  especial- 
ly pains  localized  in  the  chest.    Such  pains  are  variously  referred 


130  DUSTY  AIR    AND   ILL   HEALTH. 

to  as  pleurisy  or  a  stitch  in  the  side,  intercostal  neuralgia,  neu- 
ralgia or  rheumatism.  She  had  tried  different  physicians  and  had 
been  dosed  with  all  sorts  of  "anti"  remedies,  especially  with  sup- 
posed anti-rheumatic  drugs.  She  complained  that  she  had  more 
difficulty  in  the  winter  than  in  the  summer  and  accused  the  cli- 
mate. She  came  to  give  me  a  trial.  When  I  studied  her  history, 
including  her  symptomatology,  I  came  to  the  conclusion  she  was 
a  dust  victim.  I  found  her  ill  health  varied  according  to  where 
she  had  lived  in  town ;  she  complained  greatly  in  the  heart  of  the 
city  and  comparatively  little  in  the  outskirts  where  she  now  lives, 
here  mainly  after  acute  exposures.  I  tried  to  explain  the  nature 
and  cause  of  her  ill  health,  that  it  was  not  due  to  our  climate.  In 
the  course  of  time  the  assumption  was  verified.  She  had  a  number 
of  exposures,  as  on  railway  trips,  shopping,  etc.  Her  experience 
soon  convinced  her  that  the  only  thing  she  had  to  guard  against 
was  infection  in  the  air. 

One  day  she  spoke  of  some  friends  who  had  removed  to  the 
northwest.  One  had  been  complaining  like  herself  but  in  the  new 
home  all  troubles  disappeared.  Naturally  the  change  was  ascribed 
to  the  "wonderful  climate."  My  patient  knew  better;  but  when 
she  continued  to  receive  glowing  accounts  of  the  "wonderful  cli- 
mate" and  how  easy  it  was  to  maintain  health,  she  concluded  to 
go  there  with  her  family,  especially  as  one  of  her  children  was 
complaining  greatly,  being  also  a  dust  victim. 

Before  my  patient  left  I  explained  to  her  quite  fully  how  man 
modifies  his  surroundings  and  indeed  the  very  air  he  breathes. 
He  entirely  alters  the  face  of  the  earth.  He  cuts  down  the  forest, 
and  fields  of  grain,  or  crowded  cities,  take  its  place;  the  bare 
prairie  or  desert  is  altered.  In  a  new  country  potatoes  or  peach 
trees  are  not  found  growing  wild,  nor  does  one  find  the  common 
household  pests  and  parasites,  nor  the  common  diseases  of  civiliza- 
tion. People  are  healthy  in  the  new  home  because  the  old  diseases 
have  not  yet  been  brought  in,  they  will  all  appear  in  time. 

Now  there  are  people,  patients,  who  readily  understand  ex- 
planations and  always  remember  them.     They  will  live  up  to  the 


Cotj>ft  and  catarrh.  131 

spirit  of  the  explanation  and  not  merely  to  the  letter,  in  other 
words,  they  reason  about  things.  I  had  assumed  that  this  patient, 
would  always  remember  what  had  been  told  her,  but  subsequent 
events  showed  that  it  was  the  old  story,  Out  of  sight,  out  of  mind. 
Unless  some  people  are  constantly  in  the  care  of  a  physician  to  re- 
mind them  they  forget. 

This  patient  in  her  new  home  in  North  Dakota  had  good  health. 
Tier  sickly  child  also  had  good  health  and  grew  up  "strong  and 
health}'. "  But  life  in  the  new  community  was  quite  primitive 
and  she  soon  tired  of  it;  she  wanted  to  live  among  people.  She 
was  still  influenced  by  the  idea  of  healthy  and  unhealthy  climates 
and  induced  her  husband  to  remove  to  arid  Colorado,  the  land  of 
much  sunshine.  Here  she  lived  in  a  small  and  clean  town  and  had 
good  health,  but  her  husband's  business  was  not  good  and  soon 
another  change  was  made,  this  time  to  southern  California,  which 
also  is  said  to  have  a  "healthy  climate."  Unfortunately  her  new 
home  was  near  the  heart  of  a  large  city  and  then  both  she  and  her 
daughter  began  to  complain  more  and  more.  I  learned  this  through 
mutual  friends  who  saw  the  explanation  and  marvelled  that  she 
did  not  see  it  and  that  others  do  not  see  it. 

What  does  a  man  do  in  a  new  home?  Does  he  take  up  farming 
and  lead  an  outdoor  life,  or  does  he  work  in  a  store  in  the  heart 
of  a  crowded  city?  Does  his  family  live  in  the  suburbs  or  in  the 
heart  of  the  city  ?  To  what  extent  are  dust  influences  and  weather 
and  climatic  influences  confounded? 

LOCALIZED  PAIN.    BACKACHE.    "RHEUMATIC  CASES." 

My  first  practical  experience  as  a  physician  was  obtained  in  a 
large  city.  I  treated  people  to  the  best  of  my  ability.  I  now  see 
how  I  wholly  misunderstood  many. 

One  of  my  first  patients  was  a  "backache  case,"  a  man  ap- 
proaching middle  age.  He  gave  a  history  of  "specific  infection" 
followed  by  "blood  poisoning"  and  that  in  turn  followed  by 
"rheumatism  of  the  back."  Under  the  free  use  of  iodides  the 
"backache  or  rheumatism  or  whatever  it  was"  quickly  left.     The 


132  DUSTY  AIR  AND  ILL  HEALTH. 

man  was  so  pleased  that  he  recommended  me  right  and  left,  espe- 
cially to  people  who  were  "rheumatic."  Unfortunately  I  failed  in 
practically  every  case;  some  had  had  iodides  before — and  if  that- 
had  been  the  cure  they  would  not  have  come  to  me. 

Individuals  who  have  localized  pains  (as  a  backache  or  lum- 
bago, chest  pains,  especially  in  cases  where  such  names  as  pleurisy, 
pleurodynia  and  intercostal  neuralgia  are  used,  or  where  the  pain 
is  in  one  of  the  extremities)  often  vainly  try  all  sorts  of  remedies 
and  means  to  get  relief.  One  meets  all  kinds  of  cases,  people  who 
have  tried  all  the  doctors  of  the  neighborhood,  and  perhaps  large 
city  specialists,  and  who  in  their  desperation  tried  patent  medi- 
cines in  the  hope  of  stumbling  on  to  something  that  would  help.1 
We  all  know  how  people  are  influenced  when  some  nostrum  is 
strongly  recommended  to  them.  Some  go  to  sanatoria  and  mineral 
springs;  some  are  sent  by  their  doctor  who  is  unable  to  benefit 
them.  "When  otherwise  sensible  men  and  women  who  see  the 
ridiculousness  of  faith  and  mind  cures  are  willing  to  give  these 
a  trial  in  the  hope  of  being  benefited,  one  can  see  to  what  ex- 
tent people  will  go  to  get  relief. 

There  are  of  course  all  sorts  of  causes  bringing  on  localized 
pains  and  producing  ill  health,  but  a  very  common  one  is  generally 
overlooked.  Many  of  these  individuals  are  dust  victims  and  when 
they  properly  understand  what  that  means  and  live  up  to  good 
air  advice  they  are  greatly  benefited. 

A  young  man,  cashier  in  a  bank,  came  to  me  complaining  of 
rheumatism;  besides  severe  pain  in  the  shoulder  there  was  more 
or  less  aching  throughout  the  body,  particularly  along  towards 
spring,  more  especially  at  times  when  liquified  filth  was  tracked  in- 
doors and  pulverized,  when  there  would  be  a  black  streak  from 
the  door  to  the  cashier's  window.  My  explanation  of  dust  in- 
fection was  too  simple;  he  did  not  believe  it  and  moreover  "no 
doctor  ever  told  me  of  that  before."  He  did  not  return.  I 
should  have  made  the  explanation  more  guardedly.  A  year  later 
he  returned,  saying  he  had  observed  himself  and  he  believed  there 

1  People  afflicted  in  this  way  can  perhaps  profitably  read  Lent's  "Being  Done  Good."    It  gives  a 
more  or  less  humorous  account  of  a  man  who  was  sadly  afflicted  and  was  trying  to  find  relief. 


COLDS   AND    CATARRH.  133 

was  something  in  the  dust  theory  after  all,  and  then  he  told  of 
recently  having  been  to  a  physician  who  proposed  to  ''knock  out 
the  rheumatism"  but  instead  "knocked  out  the  stomach."  In 
addition  to  his  other  complaints  he  was  now  suffering  from  a  de- 
ranged alimentary  tract. 

In  the  course  of  time  this  man  discovered  that  there  was  no 
cure  properly  speaking,  that  it  was  a  matter  of  prevention,  and 
then  one  day  he  packed  up  and  went  to  the  Pacific  Coast  and  since 
then  has  had  "the  best  of  health." 

Mr.  — ,  a  middle-aged  mechanic,  has  been  with  me  since  early 
1903.  He  has  had  all  sorts  of  experiences.  Being  a  man  with  a 
family  and  not  being  foot-loose  like  the  man  just  mentioned,  he 
can  not  make  any  radical  change,  in  fact  being  a  poor  man  he  is 
compelled  to  work  under  adverse  air  conditions  and  continues  to 
suffer.  At  times  he  has  severe  attacks  of  pain,  "rheumatism  or 
neuralgia  or  whatever  it  is,"  in  the  side  and  back.  The  man  is 
a  good  citizen,  in  short  the  kind  of  man  who  is  apt  to  get  the 
best  one  has  to  give — but  what  is  to  be  expected  in  the  case  of  a 
poor  man  dependent  on  his  daily  labor  who  has  nothing  laid  up 
for  the  proverbial  rainy  day;  who  can  not  take  a  needed  vacation 
or  a  few  days'  rest  when  sickness  impends;  who  can  not  afford  a 
trained  nurse  in  case  of  confinement  to  bed,  and  who  is  wholly 
unable  to  live  up  to  good  air  advice? 

I  soon  determined  the  man  was  a  dust  victim  and  attempted  to 
explain  what  that  meant,  what  he  must  do  to  be  saved.  One  must 
give  more  or  less  medicine  along  with  good  advice.  I  tried  to 
supervise  health,  to  point  out  how  he  could  reduce  his  ill  health 
and  acute  attacks  to  a  minimum,  but  perhaps  needless  to  say  the 
man  who  can  not  live  up  to  advice  will  continue  to  suffer.  He  gets 
along  fairly  well  during  the  open  door  season  but  complains  great- 
ly during  the  closed  door  season,  and  especially  at  darkest  before 
dawn.  He  is  able  to  pay  only  small  fees,  yet  I  was  willing  to 
carry  him  because  I  was  getting  data.  True  it  is  only  a  repe- 
tition, but  this  very  repetition  is  what  confirms  one's  belief  in  the 
correctness  of  a  theory,  the  theory  of  dust  infection. 


134  1H  STY    AIR    AND    ILL    HEALTH. 

He  had  consulted  a  number  of  physicians  before  coming  to  me, 
including  men  who  claim  to  be  specialists,  but  who  were  not  such 
properly  speaking.  The  fact  that  he  remained  with  me  all  these 
years  must,  be  considered  good  evidence  that  I  benefit  him  more 
than  any  other  physician.  In  the  course  of  years  the  reaction 
at  darkest  before  dawn  has  been  more  and  more  severe  and  this 
last  year  he  became  desperate. 

Occasionally  I  had  an  opportunity  of  discussing  specialists  with 
him  not  only  regarding  himself  but  also  other  members  of  his 
family.     He  may  or  may  not  have  followed  my  advice. 

People  in  ill  health  and  disease  often  need  the  services  of  a 
specialist,  of  the  man  who  has  special  knowledge.  How  do  people 
know  who  is  the  proper  man.  the  best  man,  to  consult  ?  Many  are 
woefully  ignorant,  so  ignorant  that  they  believe  the  man  who  ad- 
vertises himself  as  a  specialist  in  the  newspapers  is  the  one  to 
consult,  when  as  a  matter  of  fact  he  is  the  last  man  in  the  world 
to  consult.  The  real  specialist  does  not  advertise,  unless  it  be  by 
presenting  papers  before  medical  societies  and  publishing  papers 
regarding  his  work  and  cases  and  thereby  acquainting  fellow- 
ph}rsicians  with  his  work  and  the  kind  of  cases  for  which  he  is 
qualified  and  which  he  seeks.  The  general  practitioners,  not  to 
speak  of  specialists,  send  him  cases — and  often  the  best  service  the 
physician  can  do  an  applicant  is  to  refer  him  to  the  proper  spe- 
cialist. 

But  when  a  physician  has  repeatedly  made  all  necessary  ar- 
rangements and  has  written  the  specialist  to  be  on  the  lookout, 
and  when  one  finds  that  the  individual,  "the  case,"  went  else- 
where, one  questions,  "Is  it  worth  while?" 

During  the  unusually  severe  attack  of  last  spring  he  became 
desperate.  He  asked  me  what  I  thought  of  going  to  a  large  city 
specialist,  one  recommended  by  fellow-workmen.  What  shall  one 
say?  How  much  time  and  attention  does  a.  poor  man  get  from  a 
busy  large  city  specialist  who  counts  his  time  by  minutes  and  who 
may  not  give  a  poor  man  the  necessary  time  to  make  a  proper  in- 
vestigation, and  failing  to  do  so  how  can  he  benefit?    My  patient 


COLDS   AND    CATARRH.  135 

thought  the  experience  of  a  great  specialist  might  enable  him 
promptly  to  recommend  something  that  would  help.  We  discussed 
the  pros  and  con. 

Unfortunately  I  did  not  know  the  specialist  who  had  been  rec- 
ommended to  him.  I  told  my  patient  there  are  sorts  of  specialists, 
some  real,  others  pseudo.  The  real  specialist  who  cultivates  a 
small  field  likely  knows  his  field  well,  if  a  man  properly  "belongs" 
to  such  a  specialist  he  is  apt  to  get  the  best  that  Medicine  has  to 
offer.  On  the  other  hand  the  specialist  who  "specializes"  in  every- 
thing that  those  Avho  come  to  him  complain  of,  and  who  scarcely 
rejects  any  applicant,  is  only  too  common;  the  patients,  or  "cases" 
(or  shall  one  say  dupes?)  of  such  men  are  to  be  pitied.  How  shall 
one  distinguish  between  the  two? 

The  real  specialist  gets  his  patients  through  the  recommenda- 
tion of  fellow-physicians  and  of  people  who  have  been  benefited  by 
him.  He  does  not  advertise  in  the  newspapers.  The  pseudo- 
specialist  on  the  other  hand  gets  his  patients  mainly  through  news- 
paper advertising. 

The  real  specialist  writes  for  the  medical  journals,  as  already 
mentioned;  he  tells  of  his  experiences  for  the  benefit  of  other 
physicians.  If  he  finds  or  discovers  anything  new  he  tells  it;  he 
does  not  have  any  secret  remedies  or  methods.  The  man  who  has 
such  quickly  finds  himself  repudiated  by  his  fellow-physicians. 
Just  to  what  extent  a  man  writes  for  the  medical  journals,  or  in- 
deed a  book,  may  depend  on  many  factors,  but  usually  men  who 
are  specialists  go  on  record  so  that  other  physicians  know  what 
they  do.  What  a  man  publishes  largely  determines  the  kind  of 
cases  physicians  send  him.  When  a  physician  is  asked  to  recom- 
mend a  specialist,  if  he  does  not  know  the  man  he  is  likely  to  look 
up  what  he  has  written. 

The  pseudo-specialist  or  charlatan  or  quack,  on  the  other  hand, 
neither  tells  of  his  discoveries  nor  writes  for  reputable  medical 
journals.  He  is  very  apt  however  to  tell  of  "wonderful  discover- 
ies" and  of  great  skill  and  "eminent  success"  in  the  newspapers. 
But  there  is  nothing  tangible;  his  "discoveries"  are  kept  secret. 


136  DUSTY   AIR    AND    ILL    HEALTH. 

Now  the  specialist  ray  patient  had  heard  of  through  fellow- 
shopmen  was  a  man  whom  I  did  not  know;  I  did  not  even  recall 
that  I  had  ever  heard  of  him.  I  told  my  patient  I  would  look  him 
up  to  see  what  he  had  written  on  the  subject,  about  the  particular 
complaints  of  my  patient.  He  at  once  assured  me  that  the  man 
was  "all  right,"  and  when  I  saw  that  he  was  determined  to  go  to 
him,  was  it  worth  while  to  continue  the  discussion?  Under  such 
circumstances  a  physician  usually  washes  his  hands  of  the  case, 
in  other  words  he  severs  the  relationship  of  physician  and  patient. 
I  felt  inclined  to  do  that — but  I  wanted  more  data,  and  unless  the 
man  reported  I  would  get  little  or  nothing.  I  asked  him  to  let 
me  know  what  the  specialist  said. 

He  returned  in  a  week.  It  was  clearly  to  be  seen  that  he  came 
in  the  spirit  of  the  man  who  obliges  another,  as  one  who  has  some 
valuable  information  to  give.  He  told  me  of  the  "thorough  ex- 
amination" he  had  received ;  as  a  matter  of  fact  it  was  less  thorough 
than  my  own,  as  he  soon  admitted.  He  showed  me  the  prescription 
which  he  was  given ;  it  was  the  usual  ' '  anti-rheumatic ' '  kind. 

Parenthetically  it  may  be  said  that  this  prescription  differed 
from  one  previously  given  him  by  a  "specialist,"  of  the  kind  who 
specializes  in  practically  everything,  in  that  it  contained  no  "pain 
killer,"  that  is,  opiates  were  absent.  An  observing  druggist  has 
repeatedly  told  me  that  "the  old  chronics  are  very  grateful  for  a 
little  anodyne  or  narcotic  that  is  slipped  into  the  prescription ; 
they  notice  it  at  once."  This  may  make  them  feel  better  immedi- 
ately and  they  may  be  more  grateful  to  the  symptom-prescriber 
who  does  "slip  in"  things  than  to  the  scientific  physician  whose 
prescription  is  aimed  to  "gradually  remove  the  cause" — but  just 
what  some  assume  the  cause  to  be  is  difficult  to  determine.  In  the 
light  of  cases  cited  in  this  volume  it  would  be  necessary  to  remove 
some  patients  from  the  cause,  change  their  environment,  rather 
than  try  to  remove  some  internal  cause. 

I  judged  from  my  patient's  remarks  that  the  physician  he  con- 
sulted was  really  a  good  man  who  examined  according  to  the 
usual  methods  of  the  thorough-going  physician,  but  it  was  clearly 


COLDS   AND    CATARRH.  137 

evident  that  he  was  looking  for  well-defined  disease  and  did  not 
suspect  the  man  was  reacting  to  environmental  influences.  Finally 
I  asked  what  the  city  doctor  charged:  it  was  as  much  for  the 
single  consultation  and  examination  as  he  paid  me  for  a  whole 
year. 

It  was  clearly  evident  that  the  man  no  longer  regarded  himself 
as  my  patient.  He  was  taking  "the  other  doctor's  medicine." 
Under  such  conditions  one  does  indeed  feel  that  the  relationship 
of  patient  and  physician  is  severed.  But  I  had  had  the  man  under 
observation  for  so  long  that  I  knew  what  would  likely  happen: 
he  would  improve  now  that  the  open  door  season  was  at  hand,  but 
in  all  probability  later  on  would  relapse.  What  I  did  say  was 
merely  to  express  the  hope  that  the  prescription  would  benefit  him 
and  that  I  would  be  glad  to  hear  from  him  later  on. 

Then  one  week  after  another  passed.  Finally  the  closed  door 
season  arrived  and  then  one  day  he  telephoned  that  the  old  pains 
had  returned,  and  would  I  please  send  him  some  of  the  old  medi- 
cine, "You  know  what  you  used  to  give  me."  The  man  is  still 
my  patient.  One  often  swallows  his  pride  in  order  to  get  con- 
tinued data.  He  now  regards  that  trip  to  the  city  as  an  "experi- 
ment. ' ' 

Shall  one  say  that  the  poor  man  who  must  work  daily  must 
also  suffer  more  or  less  on  account  of  bad  air  conditions?  Shall 
one  say  that  if  workmen  were  properly  organized  through  Unions 
they  could  make  a  demand  for  better  ventilation? 

These  are  pitiable  cases.  What  can  such  a  man  do?  What  can 
the  physician  do?  Is  there  any  cure,  any  drug  that  will  cure? 
How  will  it  all  end?  Will  the  pain  increase  to  such  an  extent  that 
finally  there  must  be  a  radical  change? 

Here  is  a  brief  mention  of  several  cases  that  may  shed  some 
side-light  on  the  practice  of  medicine  in  the  small  community. 

Mr.  — ,  a  middle-aged  farmer  who  loafed  much  about  the  store 
of  a  small  village,  came  to  me  at  the  end  of  winter  on  account  of 
"rheumatism."  The  man  was  so  ignorant  that  I  did  not  deem 
explanations  worth  while,  but  merely  gave  what  he  wanted,  medi- 


138  DUSTY    AIR    AND   ILL    HEALTH. 

cine.  He  got  well  as  soon  as  the  open  door  season  arrived;  of 
course  he  ascribed  it  to  the  medicine. 

Among  the  people  he  sent  me  was  an  intelligent  farmer  who 
had  complained  of  rheumatism  every  winter  for  years;  he  was  now 
thinking  of  going  to  California  to  escape  our  "horrible  climate." 
1  might  have  given  him  what  he  wanted,  medicine,  but  I  thought  it 
best  to  explain,  beginning  with  indoor  climate  and  bad  air  and  in 
time  pointing  out  what  this  means.  How  much  time  shall  one  give 
in  making  explanations,  especially  if  they  seem  not  acceptable? 
He  finally  told  me  he  would  consider  the  matter  of  taking  treat- 
ment from  me;  he  failed  to  return. 

A  few  weeks  later  I  met  him  on  a  trolley  car;  from  some  re- 
marks on  the  weather  we  soon  got  to  discussing  common  ailments, 
rheumatism  in  particular.  With  ample  time  I  went  into  details 
and  answered  his  objections.  A  few  days  later  he  became  my 
patient  and  remained  for  a  long  time.  All  some  people  need  is  a 
proper  explanation. 

The  first  mentioned  farmer  relapsed  next  winter,  as  I  thought 
he  would,  and  then  I  attempted  to  explain  to  him  also — but  he 
wanted  medicine,  he  did  not  want  any  "ridiculous  explanations." 
He  sent  me  no  more  "new  patients;"  far  from  it,  he  heralded  me 
as  a  crank. 

To  what  extent  shall  one  head  off  getting  such  a  reputation? 
To  what  extent  shall  one  strive  to  acquire  the  reputation  of  being 
a  "good  doctor,  so  kind  to  the  poor?"  It  requires  only  a  few 
minutes  to  hand  out  the  desired  medicine. 

One  of  my  old  patients  who  has  "sciatic  rheumatism"  but  who 
in  reality  is  a  dust  victim  and  has  learned  to  live  within  his  limi- 
tations and  thereby  reduce  attacks  to  a  minimum,  recently  sent 
me  a  new  patient  whom  he  suspected  was  also  a  dust  victim  but 
who  resented  the  idea  of  dust  being  injurious.  My  old  patient  did 
not  enter  into  discussion  with  the  man;  he  thought  I  could  ex- 
plain better. 

I  gave  the  man  two  hours  in  examining  and  ruling  out  affec- 
tions and  diseases  and  in  advising  him  and  of  course  telling  him 


COLDS   AND    CATARRH.  139 

about  dust  influences.  He  offered  some  objections  which  I  an- 
swered briefly.  I  referred  him  back  to  my  old  patient  who  could 
make  explanations  perhaps  as  well  as  I  could,  he  could  speak  from 
personal  experience.  I  gave  him  a  prescription,  for  salicylates,  to 
be  used  only  when  pains  were  very  marked.  I  charged  him  a  dol- 
lar, telling  him  in  case  he  returned  the  fee  would  be  doubled. 

A  week  or  so  later  I  saw  my  old  patient.  He  had  a  poor 
opinion  of  the  man,  pronounced  him  "no  good,"  that  he  would 
not  listen  to  explanations  and  that  he  expressed  himself  emphatic- 
ally on  the  most  doubtful  points.  A  short  time  after  the  man 
came  back  to  me.  Often  the  printed  page  influences  people  when 
words  of  mouth  will  not,  and  so  I  gave  him  several  of  my  reprints, 
some  of  them  rare,  asking  him  to  read  and  return  them.  That 
was  the  last  I  saw  of  the  mail  and  my  reprints. 

Mr.  — ,  another  "rheumatic,"  came  to  me  recommended  by  an 
old  patient,  because  I  "study  my  cases."  Now  I  was  willing 
enough  to  study  the  case  but  I  was  unwilling  to  make  continued 
a-b-c  explanations  and  so  I  referred  the  man  to  a  young  physician 
who  himself  is  influenced  by  dusty  air  and  who  had  a  lot  of  time 
to  make  explanations  and  likely  would  give  as  good  service  as  I 
could.  Instead  of  following  this  well  meant  advice,  the  man 
"talked,"  said  I  wanted  only  rich  patients,  that  I  did  not  want 
anything  to  do  with  poor  people,  etc. 

Mr  — ,  a  middle-aged  man,  working  in  a  grain  elevator  with 
much  time  spent  in  a  filthy  office  where  men  who  chew  and  spit 
loaf,  came  to  me  from  an  adjoining  town,  "crippled  by  rheuma- 
tism." The  pain  extended  from  the  back  down  the  left  leg.  The 
man  seemed  greatly  discouraged  and  I  gave  him  nearly  two  hours 
in  examining  and  explaining  and  advising,  in  the  end  telling  him 
I  was  working  on  a  manuscript  for  a  book  which  when  it  appeared 
would  tell  him  of  dust  infection  in  some  detail.  He  expressed 
himself  so  enthusiastically  about  the  idea  that  I  gave  him  two  of 
my  very  rare  reprints  to  read  and  to  be  carefully  returned.  Then 
one  week  after  another  passed  and  I  heard  nothing  further.  Sev- 
eral months  later  an  old  patient  from  that  neighborhood  said  the 


140  DUSTY   AIR    AND   ILL    HEALTH. 

man  had  promptly  packed  up  and  gone  to  the  southwest  where  lie 
could  lead  an  open  air  life. 

Cases  like  the  above  could  be  cited  in  number  and  variety. 
A  physician  has  all  sorts  of  experiences.  Were  these  men  really 
dust  victims  ?  I  do  not  know  but  I  do  know  that  poor  people  who 
must  work  and  ignorant  people  who  will  not  learn  must  continue 
to  suffer.  Like  all  other  physicians  I  would  rather  speak  of  suc- 
cessful cases  than  of  failures.  Many  failures  are  due  to  the  fact 
that  the  patients  did  not  live  up  to  advice.  I  am  telling  about 
these  things  in  order  that  others  may  profit. 

At  times  individuals  who  have  localized  pains  and  aches  re- 
cover suddenly.  When  this  occurs  under  certain  conditions  people 
are  apt  to  marvel.     I  might  mention  a  case. 

One  of  my  patients,  a  middle-aged  housewife,  had  a  localized 
chest  pain,  a  "stitch  in  the  side,"  due  to  an  adhesion  of  the  lung 
to  the  chest  wall,  which  was  due  to  an  old  inflammation.  She 
was  a  dust  victim  and  whenever  there  was  an  acute  exposure  the 
pain  was  severe.  Moreover  she  had  lost  a  sister  through  tubercu- 
losis and  was  constantly  worrying  that  she  herself  had  it  or  would 
get  it.  She  was  greatly  benefited  by  good  air  advice,  but  since  it 
is  practically  impossible  wholly  to  avoid  exposure  every  now  and 
then  she  had  an  acute  attack.  One  day  she  was  standing  on  a 
chair  picking  cherries  when  she  felt  herself  slipping,  and  suddenly 
threw  out  her  hands  to  grasp  a  branch.  Immediately  there  was  a 
sharp  pain  in  the  side  or  chest.  Soon  she  began  to  spit  a  little 
blood.  She  sent  for  me  in  great  alarm.  I  inquired  whether  she 
had  recently  been  exposed  to  bad  air;  she  had  not.  I  offered  her 
this  explanation:  in  reaching  out  suddenly  and  violently  the  ad- 
hesion to  the  chest  wall  was  torn  loose  and  there  was  some  bleed- 
ing, but  since  she  had  not  been  exposed  to  infection  recently  I 
thought  there  would  be  no  inflammatory  process.  My  fear  that 
there  might  be  internal  hemorrhage  I  kept  to  myself.  I  would 
keep  her  under  observation  and  if  that  did  occur  speak  of  it  at 
the  proper  time.    I  expressed  my  belief  that  now  that  the  adhesion 


COLDS  AND   CATARRH.  141 

Was  torn  loose  there  would  be  no  more  stitches  in  the  side.  My 
explanation  was  a  good  one.  In  a  day  or  two  she  was  all  right 
and  since  then  there  has  been  no  localized  pain,  although  she  still 
complains,  after  the  fashion  of  simple  dust  victims,  on  exposures 
to  bad  air.  Such  an  explanation  may  be  regarded  as  a  rational 
one,  at  least  she  regarded  it  so. 

We  sometimes  hear  of  people  who  are  suddenly  cured  of  some 
affliction  that  confined  them  to  bed,  as  the  woman  who  was  bed- 
fast on  account  of  a  stiff  or  "rheumatic"  knee,  who  suddenly 
jumped  out  of  bed  when  her  house  was  on  fire  and  "was  cured." 
Often  the  adhesion  is  such  that  there  is  a  very  limited  motion. 
When  a  certain  tension  is  reached  there  is  pain  and  the  individual 
stops  further  movement,  but  if  a  sudden  violent  motion  is  made 
the  adhesion  may  be  torn  and  a  "cure  result."  Unfortunately 
the  physician  never  knows  how  far  to  go  in  making  violent  ex- 
ertions for  fear  of  doing  more  harm  than.  good.  On  the  other 
hand  there  are  men  who  do  not  hesitate;  indeed,  there  is  one 
"school  of  practitioners"  who  use  violent  methods  and  who  in 
this  way  cure  some,  but  on  the  other  hand  there  may  be  irre- 
parable damage. 

An  old  patient  with  internal  adhesion  asked  about  consulting 
such  a  practitioner,  or  shall  one  say  manipulator?  I  advised 
against  it.  Some  time  later  she  told  me  she  had  gone  and  "the 
treatment  nearly  killed  me."  People  often  speak  about  doctors 
"either  curing  or  killing."  That  is  no  joke  with  some  modes  of 
practice.  Veterinarians  largely  practice  on  that  plan.  The  very 
fact  that  such  simple  modes  of  treatment  are  not  in  general  use, 
are  often  wholly  neglected  by  regular  physicians,  means  there  is 
too  much  danger  connected  with  them  compared  to  the  small 
amount  of  good  results. 

That  violent  exertion  may  be  the  cause  of  acute  pain  is  shown 
in  the  following: 

Mr.  —  had  "rheumatism  of  the  shoulder."  He  lived  on  the. 
edge  of  town  and  was  little  exposed  to  bad  air.     I  hesitated  to 


14:2  nrsi'Y  air  and  tll  health. 

speak  of  dusty  air  but  thought  it  my  duty  to  do  so.  He  listened 
closely  aud  agreed  to  observe  himself.  Incidentally  he  spoke  of 
gardening  and  how  his  neighbor's  chickens  annoyed  him,  how  the 
other  day  when  he  found  them  scratching  a  newly  made  bed  he 
threw  a  heavy  chunk  of  wood  determined  to  kill  some.  I  recalled 
that  under  such  conditions  one's  arm  may  ache  and  the  pain  be 
misinterpreted  as  rheumatism.  When  I  mentioned  this  he  ex- 
claimed, "By  George,  I  guess  that  is  the  cause  of  my  rheumatism." 
There  are  all  sorts  of  explanations  for  "rheumatism." 

HEALTH  IN  THE  COUNTRY  AND  IN  THE  CITY. 

From  all  the  preceding  one  may  get  an  idea  that  the  city  (or 
urban  as  opposed  to  rural  life)  is  the  home  of  ill  health  and  dis- 
ease, but  when  we  examine  into  the  matter  we  find  exceptions. 
The  term  city  includes  all  sorts  of  communities;  it  is  as  broad  as 
the  term  civilization,  which  primarily  goes  back  to  "city,"  mean- 
ing that  cities  are  an  index  of  a  country's  civilization.  While  some 
cities  are  in  the  advance,  many  are  in  the  rear;  we  speak  of  "back- 
ward cities." 

The  modern  well-managed  city  is  very  different  from  that  of 
a  hundred  years  ago,  a  fact  one  fully  realizes  on  visiting  European 
cities  where  the  heart  is  closely  built  up,  quite  different  from  the 
suburbs.  Cities  in  olden  days  were  fortified  and  there  were  good 
reasons  for  having  crooked  streets,  namely  to  get  out  of  range  of 
the  invading  enemy.  Naturally  in  fortified  cities  in  times  of  war 
the  weeding  out  was  terrific.  The  death  rate  of  every  large 
European  city  even  a  hundred  years  ago  was  enormous.  It  was  a 
long  time  before  cities  began  to  supply  themselves  with  pure  water 
and  good  food,  and  only  today  are  they  making  an  effort  to  get 
good  air.  Unless  one  visits  a  city  like  Berlin  one  has  no  proper 
conception  of  what  a  clean  and  well  managed  city  means  and  how 
ill  health  and  disease  can  be  reduced  to  a  minimum,  that  is  ill 
health  from  preventable  causes.  In  all  countries  where  the  soil 
has  become  exhausted  the  food  problem  is  of  course  an  important 
cne. 


COLDS  AND   CATARRH.  143 

Some  cities  are  making  commendable  efforts  to  get  rid  of  nar- 
row and  crooked  streets  and  to  keep  streets  clean  and  to  get  good 
water,  as  well  as  to  inspect  food  supplies.  The  well-managed  large 
city  has  all  sorts  of  inspectors.  There  are  hundreds  of  men  who 
look  after  sanitary  matters;  it  will  pay  anyone  to  look  up  the 
health  report  of  such  a  city.  At  the  other  extreme  is  the  "city" 
(really  an  overgrown  village)  where  everybody  does  about  as  he 
pleases.  If  there  are  laws  and  ordinances  at  all  they  are  not 
obeyed.  Unsanitary  conditions  of  all  kinds  abound  and  there  is 
much  preventable  ill  health  and  disease. 

The  experience  of  physicians  in  treating  people  in  ill  health, 
not  to  speak  of  actual  disease,  varies  greatly.  The  country  doctor, 
living  among  people  leading  a  simple  life  and  seldom  coming  un- 
der city  influences,  may  be  able  to  trace  causes,  he  may  be  able 
to  trace  ill  health  to  its  source,  just  as  he  may  be  able  to  trace 
smallpox  and  scarlet  fever.  The  physician  practicing  in  a  cleanly 
suburb  may  also  be  able  to  trace  causes  of  ill  health.  On  the  other 
hand  the  physician  in  the  slums  may  meet  so  much  common  ill 
health  that  he  may  not  make  any  attempt  to  treat  cases  other  than 
by  giving  a  little  medicine,  and  that  is  all  many  poor  people  ex- 
pect: the  same  is  true  of  physicians  in  backward  towns  and  neg- 
lected county-seats  where  no  attention  is  paid  to  sanitation.  If 
they  attempt  to  trace  the  causes  of  ill  health  at  all  they  may  be 
baffled  on  account  of  many  factors  that  enter  into  the  matter, 
including  bad  water  and  bad  food.  The  term  baffled  is  the  proper 
one  to  use ;  newspapers  are  constantly  telling  about  how  the  doc- 
tors are  baffled. 

At  this  place  it  is  proper  to  say  that  my  own  studies  of  Dust 
Influences  have  been  pursued  during  the  last  eleven  years  in  a 
small  spitter's  town  of  about  20,000,  where  little  attention  is  given 
to  sanitation  and  where  the  bad  air  factor  is  especially  noticeable. 
Besides  townspeople  one  of  course  meets  any  number  of  country 
people,  some  from  remote  and  isolated  portions  of  the  county  or 
adjoining  counties,  like  the  farmer  boy  already  mentioned.  But 
one  also  meets  people  from  large  cities,   as  for  instance  people 


144  DUSTY   AIR   AND   ILL   HEALTH. 

visiting  relatives.  They  may  have  had  much  ill  health  iu  large 
cities  and  may  be  induced  to  consult  the  small  town  doctor,  for  we 
all  know  how  people  will  recommend  "my  doctor."  And  then 
there  are  people  from  the  large  city  who  come  to  the  small  one 
to  make  a  home.  People  coming  from  the  densely  settled  heart 
of  a  large  city  to  a  small  town  may  find  conditions  far  healthier 
than  in  the  old  home;  for  one  thing  rent  is  cheaper  and  there  is 
less  crowding.  Then  again,  the  man  who  had  an  office  in  a  tall 
clean  office  building  down  town  may  find  his  new  office  on  a  spit 
street  in  a  small  city  quite  different.  He  may  have  had  good 
health  in  the  large  city  but  suffers  in  the  small  one.  I  might 
briefly  mention  an  illustrative  case  report,  a  young  man  who  came 
here  from  a  clean  Eastern  city. 

A  Rheumatic  Case.  One  of  my  old  patients,  a  down  town 
business  man,  several  years  ago  brought  in  a  clean,  fine  looking 
young  man  of  about  25  years,  who  had  recently  come  here,  on  the 
close  of  winter.  After  a  few  preliminary  remarks  he  said:  Now 
Doctor,  in  the  very  beginning  I  want  to  tell  you  that  until  I  came 
here  I  never  had  any  illness  since  I  had  the  common  affections  of 
childhood.  I  have  always  had  the  best  of  health.  I  take  care  of 
myself  and  have  no  bad  habits.  I  am  a  moderate  eater  and  re- 
cently have  been  undereating  thinking  that  would  help.  I  do  not 
drink  and  use  very  little  tobacco.  Now  I  can  not  understand  what 
is  the  matter.  Soon  after  I  came  here  I  began  to  feel  sore  in  the 
chest;  my  family  never  had  any  lung  trouble.  Then  the  pains 
became  more  severe  and  travelled  into  the  shoulder  and  down  the 
arm ;  I  thought  it  must  be  rheumatism,  but  when  I  began  to  ache 
all  over  the  body  I  thought  it  must  be  something  else.  I  wanted 
to  go  to  a  doctor  but  did  not  know  to  whom,  and  so  I  asked  my 
friend  here  and  he  said  you  would  quickly  tell  me  what  my  trouble 
is.  (I  looked  at  my  old  patient;  he  winked  but  did  not  say  any- 
thing.) 

Well,  did  Mr.  X  (my  old  patient)  tell  you  what  he  thought 
your  trouble  is?     "No." 


COLDS   AND    CATARRH.  ]45 

Mr.  X  spoke  up.  "If  I  had  tried  to  tell  him,  he  would  not 
have  believed  me  and  so  1  brought  him  up  for  you  to  tell  him." 

Now  here  was  a  young  man  in  a  small  town,  with  an  office  on 
one  of  our  worst  spit  streets  and  with  clouds  of  infected  dust  blow- 
ing about.  He  reacted  almost  at  once.  I  explained  his  difficulties 
as  being  a  reaction  to  an  unsanitary  environment.  He  listened 
closely,  asking  a  question  now  and  then,  and  finally  said,  "Well, 
if  that  is  the  cause  of  my  ill  health  I  know  what  to  do" — he  left 
town  shortly  after.     In  his  old  home  in  the  East  he  had  good  air. 

This  patient  of  course  was  under  observation  too  short  a  time 
to  enable  one  to  speak  definitely.  Instead  of  speaking  of  patient 
I  should  have  said  "case,"  for  nothing  further  was  done;  I  did 
not  prescribe  any  medicine.  Perhaps  the  diagnosis  made  by  my 
old  patient  who  brought  the  man  to  me  is  as  good  as  any,  "Spit 
Dust  Rheumatism,"  not  on  elegant  name  but  certainly  expressive. 

The  term  Rheumatism  is  an  old  one,  like  many  another;  it  is 
vague,  all  sorts  of  cases,  of  pains  and  aches,  are  grouped  under  it. 
Acute  articular  rheumatism  (a  supposed  definite  disease)  is  rare 
in  this  community,  "rheumatism"  itself  is  excessively  common. 
There  are  of  course  all  sorts  of  causes  for  ' '  rheumatism, ' '  but  a  very 
common  one,  the  inhalation  of  infected  dust,  is  generally  overlooked. 
The  connection  of  "rheumatism"  with  tonsillitis  or  sore  throat  has 
long  been  recognized  and  some  throat  troubles  are  called  "Rheu- 
matic Sore  Throat,"  but  that  air  conditions  are  at  the  bottom  is 
seldom  mentioned. 

Often  "rheumatism"  or  "rheumatic  pain"  is  localized  perhaps 
at  the  site  of  an  old  injury.  Since  my  personal  experience  with 
backaches  (p.  81)  I  have  realized  the  importance  of  making  in- 
quiries into  past  histories,  and  one  of  my  earliest  "dust  papers" 
was  on  just  such  cases.  I  have  seen  a  large  number  of  cases  and 
the  advice  to  avoid  bad  air  has  helped  many  a  patient  to  reduce 
his  pains  and  aches  to  a  minimum,  after  trying  all  sorts  of  rem- 
edies, cures  and  treatments. 

Perhaps  it  should  be  added  that  a  large  percent  of  such  cases 
have  the  pain  localized  in  the  back,  and  if  the  pain  is  "over  the 

[10] 


146  DUSTY   AIR   AND   ILL   HEALTH. 

kidneys"  many  have  a  belief  that  there  may  be  "kidney  disease." 
This  idea  is  fostered  by  some  patent  medicine  men  who  say  back- 
ache means  Bright 's  disease.  As  a  matter  of  fact  there  may  be 
no  pain  at  all  in  the  back  in  cases  called  Bright 's  disease. 

THE  AIR  OP  PLACES. 

The  idea  that  the  air  of  a  place  has  an  influence  on  health  and 
ill  health  and  disease  is  a  very  old  one.  Hippocrates  twenty-five 
hundred  years  ago  wrote  a  treatise  on  The  Air  of  Places;  it  is 
still  interesting  reading.  As  a  rule  medical  writers  have  specific 
diseases  in  mind ;  malaria  is  perhaps  more  frequently  considered 
than  any  other  disease.  The  subject  is  a  large  one;  here  I  desire 
to  make  a  few  remarks.  It  should  constantly  be  kept  in  mind  that 
in  this  volume  I  am  concerned  with  ill  health ;  remarks  on  diseases 
are  to  be  considered  incidental. 

Men  explain  things  in  the  light  of  existing  knowledge.  The 
explanations  of  Hippocrates  seem  very  crude  to  us;  they  are  quite 
different  from  those  of  the  chemist  of  say  fifty  years  ago,  just  as 
those  of  the  latter  are  different  from  those  of  the  bacteriologist 
of  today.  The  books  of  different  generations  explain  things  differ- 
ently. Explanations  of  the  causes  of  ill  health  are  now  mostly  in 
terms  of  bacteriology.  The  chemist  explained  bad  air  mainly  by 
the  amount  of  carbonic  acid  gas,  the  bacteriologist  by  the  kind  and 
number  of  microbes.  Naturally  one  questions,  Is  bacteriology  able 
to  explain  all?    Medicine  like  everything  else  is  an  evolution. 

"We  sometimes  see  the  statement  in  print  that  "Germs  are 
everywhere,"  meaning  of  course  disease  germs.  The  statement 
however  is  not  true,  not  even  when  applied  to  harmless  bacteria, 
and  harmless  bacteria  immensely  outnumber  injurious  ones.  The 
air  on  high  mountains  is  free  from  germ  life,  likewise  the  air  on 
midocean.  They  can  not  and  do  not  flourish  under  such  surround- 
ings. 

It  has  been  observed  that  some  small  islands  in  the  ocean  have 
insects  that  are  wingless.     This  at  first  sight  is  mystifying  but 


COLDS   AND    CATARRH.  147 

the  explanation  is  not  far  to  seek.  Insects  that  fly  are  swept  out 
into  the  ocean  by  strong  winds,  only  those  that  are  wingless  and 
live  near  the  ground  survive.  Just  as  insects  that  rise  up  into  the 
air  are  blown  out  into  the  ocean  so  disease  germs  are  blown  away 
and  the  small  island  is  "healthy." 

In  reading  about  the  buffalo  on  the  dry  arid  plains  of  the 
southwest,  we  learn  that  the  Indians  and  early  white  hunters  hung 
up  pieces  of  meat  to  dry  in  the  air,  making  jerked  beef.  The  air 
of  that  thinly  settled  country  was  so  pure  that  there  were  not  even 
the  common  germs  of  putrifaction.  Things  dried  without  under- 
going decomposition.  Today  we  can  dry  meat  only  in  a  hot  oven 
that  sterilizes  everything.  The  air  of  cities  is  so  full  of  bacteria 
and  fungoid  forms  of  life  that  produce  decomposition  that  a  few 
hours  exposure  to  the  air  in  warm  weather  is  sufficient  to  spoil 
food. 

Again,  we  are  constantly  reading  about  milk  full  of  bacteria, 
but  we  should  keep  in  mind  that  that  means  milk  sold  in  the  city. 
Milk  in  isolation,  in  the  country,  is  as  pure  as  ever ;  when  it  leaves 
the  farm  it  tends  to  become  contaminated,  especially  when  handled 
by  careless  and  dirty  people. 

"We  also  hear  it  said  that  the  Bacillus  tuberculosis,  the  germ 
of  consumption,  is  found  everywhere.  In  reality  the  statement 
applies  only  to  communities  where  people  are  massed  together. 
It  is  absent  on  mountain  and  sea,  in  forest  and  field,  but  is  plenti- 
ful in  cities,  and  especially  in  places  occupied  by  the  sick  who  are 
careless  about  their  expectorations.  It  is  under  such  conditions 
that  the  Bacillus  tuberculosis  and  other  germs  are  common.  For 
the  same  reason  morbidity  and  mortality  rates  of  some  communi- 
ties are  high.  Old  time  prisons  were  very  unsanitary.  Air  con- 
ditions were  often  terrible  and  few  of  the  prisoners  escaped  falling 
victims  to  consumption.  Since  giving  attention  to  sanitation  the 
death  rate  on  this  account  has  been  reduced  to  a  remarkable  ex- 
tent. (It  is  rather  anamolous  that  today  people  of  this  kind  often 
get  more  attention,  are  better  housed  and  fed,  than  poor  and  hon- 
est people.) 


148  DUSTY    AIR    AND    ILL    HEALTH. 

The  Air  of  Places  under  which  people  live  and  work  is  an  in- 
teresting  subject.1     We  need  only  consider  what  occurs  in  the  life 

of  any  of  us  on  getting  up  in  the  morning.  We  get  up  with  a 
bitter  taste  in  the  mouth,  perhaps  indicative  of  having  slept  in  an 
ill  ventilated  bedroom,  or  having  visited  a  poorly  ventilated  the- 
ater last  night,  or  having  been  to  a  poorly  ventilated  church.  We 
take  the  street  car  down  town,  it  may  be  crowded  and  poorly 
ventilated  and  we  get  our  first  whiff  of  bad  air.  People  who  live 
in  the  heart  of  the  city  get  bad  air  all  night,  perhaps  the  entire 
twenty-four  hours.  Some  individuals  go  down  town  to  stay  all 
day,  to  work,  others  go  for  only  a  short  time.  Under  what  sort  of 
air  conditions  do  they  work?  The  air  conditions  of  an  office  in  a 
tall  building  where  attention  is  given  to  the  matter  of  ventilation 
may  be  comparatively  good,  while  the  air  of  a  store  with  much 
sidewalk  filth  tracked  in  may  be  very  bad.  But  we  should  not  for- 
get that  although  a  woman  who  goes  down  town  to  shop  for  an 
hour  or  two  may  come  home  feeling  bad,  yet  the  clerk  who  waits 
on  her  and  others  all  day  long  may  scarcely  complain  at  all.  Is 
it  necessary  to  add  that  the  clerk  who  can  not  "stand  the  racket" 
is  not  apt  to  occupy  such  a  position?  Out  of  the  many  who  try, 
only  a  few  succeed. 

If  we  go  by  rail  we  may  feel  the  closeness  of  the  air  in  the 
coach  and  yet  the  conductor  may  not  complain.  He  too  is  the 
survival  of  the  fittest.  The  conductor  subject  to  colds  and  ca- 
tarrh and  weeping  eyes  and  nose  and  frequently  disabled  on  ac- 
count of  sickness  is  not  apt  to  occupy  such  a  position.  Hence  in 
considering  the  air  of  places  we  must  also  consider  the  people  and 
their  adaptation  to  it.  Some  are  better  adapted  than  others  to 
live  under  unsanitary  surroundings.  When  we  read  of  crowded 
Chinese  cities  we  may  not  be  surprised  that  the  Chinese  can  live 
in  our  large  cities  under  surroundings  that  are  fatal  to  the  white 
man. 


1  In  small  communities,  especially  county-seats,  certain  street  corners  are  favorite  loafing  places 
and  in  the  absence  of  "moving  on"  and  "anti-spitting"  ordnances,  or  if  there  are  such,  their  non- 
enforcement,  the  sidewalks  may  present  sights  almost  unbelievable.  The  need  for  cleaning  up  and 
flushing  streets  and  sidewalks  frequently  must  be  apparent — and  the  need  for  repressing  the  spitter 
more  so. 


COLDS   AND   CATARRH.  140 

We  all  know  that  some  trades  and  professions  are  regarded  as 
healthy,  others  unhealthy.  Open  air  people  are  apt  to  live  long, 
those  living  under  confined  air  conditions,  perhaps  much  in  con- 
tact with  people  in  ill  health  or  disease  or  the  causes  thereof, 
may  be  short  lived.  The  preacher  who  is  exposed  to  bad  air  once 
or  twice  a  week  may  yet  have  a  better  expectancy  for  long  life 
than  the  physician  who  is  constantly  visiting  poor  sick  people  in 
neglected  homes.1 

The  physician  who  goes  to  a  distant  country  to  study  yellow 
fever  or  plague  victims  may  be  virtually  committing  suicide.  The 
same  may  be  said  of  the  missionary  who  goes  to  a  country  where 
diseases  prevail  to  which  his  ancestors  had  not  been  exposed. 

As  already  mentioned,  the  Father  of  Medicine  twenty -five  hun- 
dred years  ago  wrote  about  the  Air  of  Places.  Benjamin  Franklin 
had  some  good  ideas  regarding  the  importance  of  proper  ventila- 
tion. Physicians  today  are  fully  alive  to  the  importance  of  good 
air  in  the  prevention  and  treatment  of  tuberculosis ;  they  are  just 
beginning  to  realize  the  value  of  good  air  in  the  prevention  and 
treatment  of  ill  health.  We  are  only  beginning  to  realize  the  sig- 
nificance of  air  and  dust  influences.  A  short  time  ago  I  received 
a  circular  from  a  German  sanatorium  which  laid  special  emphasis 
on  "Staub — freie  Luft."  Moreover  there  is  developing  a  tendency 
for  hospitals  to  leave  the  heart  of  the  city  and  go  to  the  suburbs. 
We  of  course  must  make  distinctions  between  surgical  cases  and 
cases  of  well-defined  disease  and  of  mere  ill  health.  Some  hospitals 
of  necessity  must  be  in  the  heart  of  the  city.  Sanatoria  should  be 
in  the  suburbs  or  country. 

Men  in  writing  about  phenomena,  about  facts,  are  inclined  to 
add  their  explanations.  When  we  read  old  time  accounts  we  may 
be  willing  to  accept  statements  of  facts  but  we  may  wholly  reject 
the  explanation;  we  say  we  know  better. 

1  And  what  shall  be  said  of  air  conditions  under  which  doctors  meet?  Are  doctors  so  accustomed 
to  bad  air  that  they  pay  no  attention  to  the  air  of  their  meeting  places?  I  have  frequently  attended 
meetings  in  tightly  closed  rooms  with  the  air  densely  filled  with  tobacco  smoke.  One  almost  feels 
like  saying  that  the  doctors  of  least  importance  in  a  community  and  of  least  importance  to  medical 
societies  are  the  inveterate  smokers,  with  few  exceptions.  Chewers  with  decorated  shirt  fronts  are 
now  seldom  seen  at  medical  society  meetings. 


150  DUSTY    AIR    AND   ILL    HEALTH. 

In  going:  over  my  ease  reports  the  reader  should  keep  in  mind 
what  are  statements  of  facts  and  what  are  conclusions  or  expla- 
nations. Explanations  given  in  this  volume  may  appeal  to  the 
reader  who  is  a  dust  victim  and  who  has  been  observant;  others 
may  be  strongly  inclined  to  reject  them.  Some  of  my  best  pa- 
tients were  at  first  strongly  opposed  to  the  idea  that  dust  affected 
them,  that  they  were  dust  victims.  The  willingness,  not  to  speak 
of  the  ability,  to  observe  and  keep  a  record  is  an  important  factor 
in  deciding  who  are  "best  patients"  and  who  remain  from  one 
year  to  another.  It  is  from  such  patients  that  physicians  may 
learn  much  in  the  course  of  years. 

When  patients  object  to  the  explanation  offered,  the  question 
arises,  Do  you  know  a  better  one  for  the  facts?  How  do  you  ex- 
plain the  presence  of  so  much  ill  health  in  some  communities,  the 
sallow  complexions  of  people,  with  newspapers  full  of  patent  medi- 
cine advertisements? 

Needless  to  say  all  case  reports  are  partial ;  they  dwell  on  cer- 
tain facts  and  neglect  others.  To  arrive  at  valid  conclusions  the 
reader  should  study  nature  at  first  hand;  he  should  not  form  his 
opinions  altogether  from  books.  The  reader  who  has  ill  health 
that  has  not  been  satisfactorily  explained  may  learn  much  by 
studying  The  Air  of  Places,  the  air  which  he  breathes. 


V. 
DYSPEPSIA. 


Everybody  has  an  idea  of  the  significance  of  this  term.     It  is 

an  old  word,  going  back  to  the  ancient  Greeks,  literally  meaning 

difficult  or  poor  digestion.     The  Century  Dictionary  says: 

"Impaired  power  of  digestion.  The  terra  is  applied  with  a  certain 
freedom  to  all  forms  of  gastric  derangement,  whether  involving  impaired 
power  of  digestion  or  not.  But  it  i's  usually  discarded  when  some  more 
definite  diagnosis  can  be  made,  as  gastric  cancer,  gastric  ulcer,  gastritis, 
gastrectasia,  or  when  it  depends  on  poisonous  ingesta  or  appears  as  a 
feature  of  some  other  disease,  especially  if  that  is  acute.  Functional  dys- 
pepsia, also  called  atonic  and  nervous  dyspepsia,  is  gastric  derangement, 
not  exclusively  neuralgic,  which  may  involve  a  diminished  or  excessive 
secretion  of  the  gastric  juice,  or  diminished  or  excessive  acidity  in  that 
secretion,  or  an  irritability  of  the  stomach  walls  or  an  impairment  of  their 
motor  functions,  and  which  appears  to  depend  on  some  defect  in  the  inner- 
vation of  the  stomach,  and  not  on  some  grosser  lesion." 

The  term  is  one  of  convenience  used  by  people  in  discussing 
their  ills;  it  is  also  used  by  the  doctor  in  giving  superficial  ex- 
planations to  his  patients. 

There  are  all  sorts  of  causes  that  produce  derangement  of  the 
digestive  functions,  some  readily  ascertainable,  others  only  after 
much  investigation,  if  at  all. 

Many  of  my  early  patients  complained  of  dyspepsia,  of  a  dis- 
turbance of  the  digestive  tract,  but  unfortunately  I  did  not  under- 
stand them.  Because  they  did  not  complain  of  colds  and  catarrh 
as  I  then  understood  the  effects  of  dust  inhalation,  I  was  misled 
and  did  not  even  suspect  that  they  were  dust  victims.  But  I  soon 
found  that  some  who  were  subject  to  "stomach  troubles"  in  addi- 
tion to  colds  and  catarrh  were  benefited  by  good  air  advice,  that 
is  they  complained  less  of  dyspepsia,  and  that  opened  my  eyes.  It 
gradually  dawned  on  me  that  some  dyspeptics  were  in  reality  dust 
victims,  dust  influences  manifesting  themselves  differently  from 
what  I  had  heretofore  observed,  in  fact  so  differently  that  one  can 
speak  of  a  dyspeptic  or  a  stomach  type  of  dust  infection. 

(151) 


152  DUSTY    AIR    AND    ILL    HEALTH. 

Many  of  my  early  patients  were  misunderstood.  This  of  course 
is  a  confession  of  ignorance.  I  no  more  understood  them  than  my 
predecessors  and  when  patients  find  out  that  a  doctor  does  not 
understand  them  and  is  not  henefiting  them  they  naturally  go 
elsewhere. 

Out  of  a  large  number  of  cases  I  shall  make  a  more  or  less 
brief  reference  to  several  that  have  been  written  up  in  a  volume 
for  physicians,  who  want  more  details.1  In  a  volume  like  this  one 
can  not  go  into,  for  instance,  the  matter  of  laboratory  findings 
or  details  of  chemical  or  microscopical  analysis. 

Among  my  first  patients  on  coming  here  in  the  summer  of  1900 
was  a  young  carpenter.  He  complained  of  dyspepsia.  He  had 
consulted  a  number  of  physicians ;  I  was  the  "new  doctor  in  town" 
and  he  came  to  "give  you  a  trial."  I  investigated,  examined,  ad- 
vised and  prescribed  but  since  I  was  not  benefiting  him  he  soon 
left.  I  kept  full  notes  on  the  case.  I  begin  a  new  set  of  notes  each 
year  and  file  away  the  old  ones.  From  time  to  time  I  go  over 
them  for  ideas  or  conclusions.  Then  it  dawned  on  me  that  while 
temporarily  out  of  the  city  doing  country  work  he  felt  all  right. 
While  he  was  my  patient  I  had  not  noticed  the  effects  of  exchang- 
ing city  air  for  country  air,  neither  did  I  reason  about  a  carpen- 
ter's occupation:  that  besides  doing  new  work  he  also  does  much 
repair  work  on  old  houses,  especially  ripping  up  dusty  floors. 

Among  early  cases  I  might  mention  Mr.  — .  He  had  for  years 
been  with  one  of  the  old  practitioners  who  was  about  to  retire  and 
was  now  in  search  of  a  new  physician.  The  man  asked  many 
questions.  I  was  at  first  surprised  but  when  I  considered  that  his 
family  physician  discussed  things  freely  with  his  patients  I  knew 
that  was  no  more  than  one  would  expect.    He  asked  me  regarding 


1  It  was  thought  best  to  abstract  cases  from  that  volume  as  a  rule  rather  than  to  make  mention 
of  other  cases.     The  reader  who  wants  more  details  can  likely  borrow  that  volume  from  some  physician. 

It  should  be  said  however  that  that  volume  was  written  from  a  very  practical  standpoint,  its  aim 
being  to  show  that  many  misunderstood  and  neglected  cases  are  dust  victims  that  can  be  greatly 
benefited  by  pure  air  advice. 

Although  Medicine  is  commonly  regarded  as  a  science  or  at  least  as  an  art,  in  reality  it  is  a  business, 
just  as  any  other  business,  and  some  doctors  find  it  very  hard  to  make  a  decent  living.  To  interest 
the  general  practitioner  of  medicine  one  must  write  from  a  very  practical  standpoint.  The  very 
scientific  physician  may  not  be  at  all  interested  in  the  common  ills  of  the  people. 


DYSPEPSIA.  153 

the  causes  of  dyspepsia.  I  told  him  there  were  all  sorts  of  causes, 
some  readily  discoverable,  others  with  difficulty,  some  not  at  all. 
He  approved  of  my  explanations,  adding  that  old  Dr.  X  all  these 
years  had  never  been  able  to  find  out  the  cause  of  his  recurrent 
attacks,  occasionally  lasting  for  weeks.  He  knew  I  had  been  to 
Germany  and  asked  regarding  stomach  examinations.  I  explained 
briefly.  The  fact  that  I  was  willing  to  answer  questions  and  that 
T  could  make  laboratory  examinations  induced  him  to  give  me  a 
trial.  He  gave  me  all  the  opportunities  possible  to  investigate 
and  to  advise  and  prescribe,  but  alas  I  benefited  him  so  little  that 
in  time  he  tried  another  doctor.  I  may  add  that  when  I  know  I 
am  not  benefiting  a  patient  and  see  no  prospect  for  doing  so,  I 
do  not  try  to  hold  him.  I  no  more  understood  the  cause  of  this 
man's  attacks  than  his  old  family  physician  had  understood  them. 

Looking  over  my  notes  now  the  case  is  perfectly  clear  to  me: 
the  man  was  reacting  to  the  air  of  an  unsanitary,  unventilated 
crowded  store.  If  he  came  back  to  me  now  I  likely  could  give  him 
advice  that  would  benefit  him.  But  after  all  would  he  follow 
advice?  In  small  communities  where  everybody  knows  everybody 
else,  the  people  are  apt  to  talk  about  the  physicians  and  their 
views  and  modes  of  treatment.  He  likely  knows  that  I  would  ad- 
vise " change  of  air,"  if  not  "change  of  climate,"  and  he  may  be 
wholly  unwilling  to  do  this.  At  any  rate  he  has  not  come  back 
to  me;  he  still  hopes  to  be  cured  by  taking  drugs. 

Since  then  I  have  seen  a  number  of  similar  cases  and  was  able 
to  give  advice  that  was  followed  by  good  results.  If  I  were  to 
write  a  chronological  account  of  my  experiences,  I  would  have  to 
mention  a  number  of  cases  that  I  misunderstood  before  coming 
to  those  I  partly  understood,  finally  coming  to  those  I  understood 
at  once.  Here  I  shall  skip  and  take  up  cases  where  I  at  once  sus- 
pected air  conditions.  I  have  already  cited  two  case  reports  from 
my  paper  on  Dust,  A  Neglected  Factor  in  111  Health  (see  pp.  84 
and  90).  I  shall  briefly  refer  to  a  third  case.  This  case  will  be 
cited  in  detail  in  a  volume  for  physicians. 

A  young  country  woman,  farmer's  maid,  had  severe  recurrent 


154  DUSTY    AIR    AND    ILL   HEALTH. 

attacks  of  "stomach  trouble"  or  acute  gastritis,  with  severe  vomit- 
ing followed  by  great  prostration.  Her  mother,  a  country  woman, 
had  been  similarly  afflicted  and  indeed  on  removing  to  the  city 
quickly  perished.  I  discovered  that  the  young  woman's  attacks 
followed  trips  to  town.  Like  most  country  people,  she  came  in 
only  on  fine  days.  Now  it  happened  that  the  day  she  came  for  an 
examination  of  the  stomach  contents  was  a  rainy  one.  I  asked 
her  to  return  the  next  day  and  I  would  explain  and  discuss  the 
laboratory  findings.  She  said  she  would  be  unable  to  come  be- 
cause she  was  sure  to  be  sick,  that  she  got  sick  every  time  she  came 
to  town !  I  expressed  my  belief  that  she  would  be  able  to  come, 
without  giving  any  reason. 

The  next  morning  she  promptly  expressed  her  surprise  that 
she  was  able  to  come,  for  she  certainly  expected  to  get  sick.  I  ex- 
plained that  she  was  a  dust  victim  and  that  she  did  not  get  sick 
because  the  day  had  been  rainy  and  she  was  in  town  only  a  few 
minutes,  that  she  did  not  do  any  shopping  and  did  not  inhale  a 
lot  of  dust. 

Dust  influences  in  this  case  manifested  themselves  at  once  by 
an  irritation  of  the  respiratory  membranes,  quickly  spreading  to 
the  esophagus  and  stomach.  The  treatment  she  had  been  getting 
(hypodermics  to  allay  the  excessive  irritability  of  the  stomach) 
only  aggravated  her  condition.     I  myself  gave  no  hypodermics. 

That  was  eight  years  ago,  the  patient  has  been  with  me  ever 
since.  At  first  she  required  much  attention  and  reported  at  short 
intervals.  It  was  difficult  for  her  to  learn  the  lesson  of  pure  air, 
or  of  avoiding  bad  air,  but  she  finally  did  learn.  She  reduced  her 
attacks  to  a  minimum  by  avoiding  exposure. 

But  at  times  there  were  attacks  when  I  could  get  no  history 
of  an  exposure,  when  she  had  been  living  quietly  in  the  country 
for  weeks  at  a  time.  Occasionally  I  was  in  doubt  whether  she  was 
really  a  dust  victim  or  whether  after  all  there  might  not  be  present 
some  disease  or  some  organic  alteration  of  the  stomach.  But  sud- 
denly some  of  these  mysterious  unaccountable  attacks  would  clear 
up.    One  day,  for  instance,  I  saw  the  farmer's  wife,  her  employer, 


DYSPEPSIA.  155 

walking  along  with  her  dress  trailing  over  the  filthy  sidewalks. 
Then  I  thought  I  saw  a  solution.  The  next  time  the  girl  came  in 
I  asked  whether  it  was  her  work  to  clean  soiled  dresses;  it  was, 
and  that  is  where  she  got  the  infected  dust. 

There  were  occasional  house  parties,  people  would  come  out 
from  town.  During  the  open  door  season  these  had  no  influence 
on  her,  but  she  would  react  during  the  closed  door  season.  People 
from  a  dirty  city  naturally  carry  a  lot  of  infection  to  an  other- 
wise clean  country  home. 

There  were  a  number  of  incidental  exposures,  as  taking  a  short 
trip  by  rail  or  going  to  Sunday  School  or  to  church.  She  could 
take  a  short  ride  or  go  to  Sunday  School  or  attend  a  short  church 
service  during  the  open  door  season  but  suffered  during  the  closed 
door  season.  One  time  she  attended  an  entertainment  at  the  opera 
house  for  the  benefit  of  her  church.  She  thought  it  her  duty  to 
attend.  The  reaction  that  followed  was  so  severe  that  she  nearly 
perished. 

In  the  course  of  several  years  her  health  improved  to  such  an 
extent  that  symptoms  and  attacks  were  reduced  to  a  minimum 
and  then  she  decided  to  marry,  moving  to  the  edge  of  a  county- 
seat  and  living  under  good  air  conditions.  From  now  on  health 
supervision  was  merely  nominal.  She  still  has  an  occasional  at- 
tack due  to  unwitting  exposure  or  an  error  of  judgment.  The 
unpaved  streets  in  the  resident  portion,  for  instance,  may  be  quite 
muddy  shortly  after  a  shower  and  she  assumes  that  air  conditions 
down  town  are  good,  when  as  a  matter  of  fact  dust  is  flying  on 
the  few  paved  streets  in  the  heart  of  the  city.  Or,  again,  during 
the  winter  time  the  ground  is  covered  with  snow.  Under  such 
conditions  one  naturally  assumes  that  there  is  no  dust  down  town. 
But  in  the  heart  of  the  city  the  snow  with  its  accumulated  filth 
is  more  or  less  melted  and  is  tracked  in,  filth  is  pulverized  and 
suspended  in  the  air  as  dust. 

When  a  physician  has  kept  such  a  patient  under  observation 
for  years,  and  has  even  obtained  an  autobiography,  enough  data 
accumulate  to  enable  one  to  write  a  book.     In  cases  of  this  kind 


156  DUSTY   AIR    AND    ILL    HEALTH. 

one  almost  feels  inclined  to  speak  dogmatically,  something  one 
must  guard  against  when  dealing  with  chronics,  because  people 
want  to  know  the  why  and  wherefore.  But  such  is  the  constitution 
of  the  human  mind  that  when  people  get  critically  ill  they  want 
a  physician  who  talks  and  acts  dogmatically  about  remedies  that 
are  supposed  to  cure — one  must  even  do  that  to  the  sick  physician 
or  he  will  not  take  his  medicine. 

I  may  add  that  the  above  patient  had  had  all  sorts  of  diag- 
noses, none  fitted.  She  was  a  dust  victim.  There  was  no  disease, 
only  a  reaction  to  abnormal  air. 

In  the  above  case  the  relationship  of  attacks  to  visits  to  town 
was  fully  recognized  by  the  patient. 

In  the  case  of  Mrs.  — ,  an  elderly  farmer's  wife,  the  relation- 
ship was  not  so  clear,  in  fact  the  patient  for  a.  long  time  denied 
that  visits  to  the  city  had  any  influence  at  all.  But  when  she  kept 
a  daily  record  Ave  found,  that  attacks  marked  by  severe  vomiting 
came  on  two  or  even  three  days  after  the  exposure — a  time  suffi- 
ciently long  to  mislead.  A  case  of  this  kind  shows  the  value  of 
keeping  a  daily  record.     Such  a  delayed  action  is  unusual. 

At  this  place  I  may  say  that  patients  who  remain  with  a  phy- 
sician from  year  to  year  and  enable  him  to  get  continued  data  are 
comparatively  rare.  People  in  ill  health,  at  least  in  the  begin- 
ning before  they  learn  through  bitter  experience,  are  always  ready 
to  change  physicians  or  medicines,  they  look  for  "cures."  The 
patent  medicine  men,  in  their  advertisements,  keep  up  the  old  time 
belief  that  diseases  are  readily  curable — and  to  the  simple  all 
things  are  simple.  A  disease  is  something  to  be  "killed"  or 
"knocked  out."  A  disease  name  is  something  definite  to  most 
people  and  is  linked  with  "cure."  The  terms  sickness  and  ill 
health  are  indefinite;  they  are  to  be  resolved  into  some  common 
term,  into  one  of  the  "disease  names"  that  we  see  in  the  adver- 
tisements of  patent  medicine. 

Unless  the  physician  takes  unusual  pains  he  rarely  gets  con- 
tinued data. 


DYSPEPSIA.  157 

As  already  mentioned,  it  may  be  comparatively  easy  to  trace 
the  causes  of  ill  health,  not  to  speak  of  disease,  among  country 
people  living  under  simple  life  conditions  and  only  occasionally 
going  into  town,  into  crowds.  But  it  may  be  almost  impossible  to 
trace  ill  health  in  those  living  under  a  complex  environment,  city 
people  generally.  I  have  repeatedly  met  farmers  whose  attacks  of 
dyspepsia,  as  well  as  other  forms  of  dust  infection,  found  their 
explanation  in  visits  to  town.  It  is  rather  strange  that  a  man 
should  not  himself  trace  the  relationship  of  cause  and  effect.  The 
reason  is  perhaps  due  to  the  fact  that  the  farmer  is  constantly 
seeing  clouds  of  dust  from  roads  and  from  his  fields  and  he  makes 
no  distinction  between  such  and  clouds  blowing  about  on  city 
streets  and  dust  found  in  stores,  churches  and  theaters.  If  a 
farmer  got  sick  every  time  he  came  to  town  he  might  at  least  trace 
a  town  relationship.  When  he  comes  to  town  on  a  rainy  day  he 
may  escape,  then  the  next  time  he  comes  on  a  dusty  day  and  gets 
an  attack  he  fails  to  trace  the  relationship  because  he  escaped  the 
last  time.  That  some  farmers  have  traced  their  sore  throats  to 
visits  to  the  city  has  already  been  mentioned.  Dust  of  course 
irritates  the  respiratory  membranes  but  that  the  alimentary  tract 
should  react  is  less  obvious,  as  a  matter  of  fact  ordinarily  physi- 
cians fail  to  consider  dust  in  their  obscure  stomach  cases.  When 
country  people  are  taught  and  understand  these  things,  how  they 
suffer  on  visits  to  the  city  and  how  doctors  fail  to  recognize  the 
nature  of  their  ill  health,  they  are  apt  to  wonder  in  regard  to  the 
doctor's  medical  education,  whether  something  has  not  been  neg- 
lected. More  than  one  of  my  patients  has  expressed  the  view  that 
before  a  doctor  begins  to  practice  he  should  have  country  experi- 
ence. He  should  go,  or  be  placed,  under  simple  country  conditions 
to  study  the  common  ills  and  their  causes,  perhaps  at  some  country 
crossroads,  and  then  go  to  the  small  town  and  study  people.  Next 
he  should  go  to  the  small  city  and  finally  to  the  metropolis  where 
there  are  all  sorts  of  sick  people  and  where  the  environment  is  so 
complex  that  it  is  difficult  to  trace  what  is  readily  traceable  in  the 
country.     As  matters  stand  at  present,  physicians  are  educated 


158  DUSTY   AIR    AND   ILL   HEALTH. 

regarding  well-defined  diseases.  They  get  little  instruction  re- 
garding common  ill  health  and  if  they  get  any  practical  experi- 
ence at  all  it  is  in  city  hospitals  with  patients  drawn  mainly  from 
city  slums,  people  who  live  under  radically  different  surroundings 
from  country  people,  in  fact  entirely  different  from  those  of  the 
average  intelligent  citizen.  Perhaps  it  is  no  wonder  that  many 
physicians  fail  in  treating  common  ill  health.  Of  the  many  appli- 
cants coming  to  the  physician  only  a  few  are  really  diseased,  the 
great  mass  have  ill  health  to  which  no  definite  name  can  be  applied. 
If  the  physician  does  give  a  name  the  next  physician  may  give  an 
entirely  different  one.  Thus  old  chronics  have  all  sorts  of  diag- 
noses— and  come  to  believe  in  none. 

The  old  chronic  who  has  had  much  experience  with  physicians 
knows  that  they  differ  greatly.  On  the  one  hand  he  meets  the 
symptom-prescriber  who  hands  out  a  bottle  of  medicine  or  a  box 
of  pills  on  the  merest  statement  of  symptoms  without  giving  any 
advice  except  how  to  take  the  medicine.  At  the  other  extreme  is 
the  scientific  physician  who  is  inclined  to  take  nothing  for  granted ; 
he  wants  to  investigate  and  make  his  own  diagnosis.  He  will 
likely  have  considerable  general  advice  to  give  and  he  will  cer- 
tainly advise  regarding  food. 

Food,  or  improper  eating,  is  most  commonly  accused  of  being 
the  cause  of  dyspepsia,  not  to  speak  of  all  sorts  of  ills.  On  the 
other  hand  we  have  the  faddist  who  claims  to  cure  all  ills  by  diet- 
ing. People  often  diet  themselves  or  they  are  advised  to  do  so  by 
physicians.  Often  the  advice  is  most  arbitrary,  as  to  avoid  fresh 
bread  or  gravy,  or  fried  meat  or  raw  vegetables  or  this  or  that. 
One  often  meets  patients  who  have  been  living  on  weak  tea  and 
toast  or  crackers  for  months  at  a  time.  What  many  need  is  a 
varied  diet. 

But  the  place  where  a  man  eats  is  often  of  more  importance 
than  what  he  eats.  A  city  man,  for  instance,  may  constantly  com- 
plain of  dyspepsia ;  he  goes  to  the  country  on  a  vacation,  perhaps 
on  a  hunting  or  fishing  expedition,  for  a  few  weeks;  soon  he  is 
able  to  eat  anything  and  everything.    When  he  returns  to  the  city 


DYSPEPSIA.  159 

his  old  troubles  come  back.  I  have  had  patients  who  took  their 
food  supplies  along,  all  except  fish  and  game  and  water,  and  who 
took  no  more  exercise  than  at  home.  They  had  no  difficulty  while 
away  but  complained  soon  after  getting  back  into  the  old  environ- 
ment. 

Several  years  ago  I  had  a  young  farmer  as  a  patient  who  re- 
peatedly expressed  his  belief  that  "It's  what  I  eat."  He  was  thin 
and  anemic  and  could  scarcely  drag  himself  around.  He  had  been 
dieting  himself.  He  found  so  many  things  disagreed  that  he  was 
almost  starved.  He  turned  out  to  be  a  dust  victim.  Now  we  know 
how  a  man  who  is  too  ill  to  work  will  make  frequent  trips  to  the 
city  or  to  the  heart  of  the  city  and  stand  around  on  street  corners 
or  spend  much  time  back  of  the  stove  of  the  village  store.  Under 
such  circumstances  the  dust  victim  only  aggravates  his  ills.  When 
I  pointed  out  why  he  probably  had  a  disturbed  stomach,  he  avoided 
infected  dust  and  in  a  short  time  was  able  to  eat  anything  and 
everything.  Then  one  day  he  went  to  a  political  rally  at  his  county- 
seat.  He  was  careful  to  avoid  indoor  crowds  but  he  mingled  freely 
with  the  crowd  on  the  street,  assuming  that  the  air  would  be  all 
right  outside.  The  next  day  he  came  in  complaining  greatly,  say- 
ing he  had  eaten  a  little  candy  and  that  upset  his  stomach.  He 
was  not  going  to  eat  any  more  candy.  He  knew,  "It's  what  I 
eat."  The  attack  passed  off  promptly  and  he  attended  another 
rally.  Again  he  came  in  complaining,  saying  he  had  eaten  a  little 
popcorn  and  that  was  the  cause ;  he  was  not  going  to  eat  any  more 
popcorn.  I  referred  to  his  previous  remark,  and  since  the  silly 
season  of  politics  had  now  closed,  I  predicted  that  he  would  eat 
pie  before  long,  for  Thanksgiving.  He  sadly  shook  his  head,  "Pie? 
I  don't  dare  to  eat  pie."  I  did  not  see  him  again  until  early  in 
the  new  year  when  he  came  in.  He  had  gained  greatly  in  weight, 
in  fact  he  looked  like  a  different  man.  I  quickly  discovered  that 
his  complaints  now  were  really  due  to  overeating.  A  short  time 
before  he  had  had  the  annual  pig-killing  and  with  a  lot  of  fresh 
meat  in  the  house  he  used  it  too  freely.  I  merely  advised  him  to 
cut  down  his  rations.    That  was  all  that  was  necessary. 


160  DUSTY    AIR    AND   ILL   HEALTH. 

The  throe  eases  mentioned  above  were  country  people,  it  was 
easy  to  trace  the  relationship  of  eause  and  effect:  I  will  now  make 
a  brief  reference  to  some  city  people. 

One  of  my  early  patients  was  a  down  town  business  man  who 
had  had  ill  health  for  years,  the  most  common  diagnoses  being 
such  simple  ones  as  "It's  the  stomach,"  "It's  the  liver."  He  had 
not  only  tried  a  number  of  local  physicians  but  had  even  been  to 
Germany.  Many  regard  the  German  specialist  as  a  sort  of  su- 
preme court:  if  he  can  not  help,  nobody  can.  The  German  special- 
ist sent  him  to  one  of  the  mineral  springs.  He  returned  home  cured, 
as  he  thought,  and  was  full  of  praises  for  German  doctors  and 
their  methods.     He  told  me  how  fully  they  examined  his  stomach. 

Having  recently  visited  Germany  myself,  I  determined  to  ex- 
amine his  stomach  according  to  the  German  books  I  brought  with 
me.  I  investigated,  examined,  advised  and  prescribed — but,  un- 
fortunately, the  man  did  not  get  better.  After  a  time  he  left  me. 
That  he  was  a  dust  victim  did  not  even  dawn  on  me.  It  is  only 
exceptionally  that  such  a  disappointed  patient  comes  back  and 
gives  one  a  second  trial,  and  then,  after  having  studied  and  bene- 
fited apparently  similar  cases,  one  may  be  able  to  give  relief. 

Another  early  case  was  that  of  an  elderly  lawyer  with  chronic 
dyspepsia,  attended  with  formation  of  much  mucus  in  the  stom- 
ach, with  more  or  less  also  in  the  respiratory  passages.  Good  air 
advice  not  only  helped  his  respiratory  catarrh  but  also  his  stomach 
catarrh  and  then  I  began  to  suspect  he  was  a  dust  victim.  I  began 
to  study  his  ill  health  in  the  light  of  air  conditions.  My  suspicions 
were  verified  in  the  course  of  time  and  then  I  began  to  insist  that 
he  live  up  to  good  air  requirements.  After  several  years  I  was 
beginning  to  lose  patience  and  spoke  rather  positively  and  then 
he  did  make  a  change — he  went  to  a  city  specialist  who  examined 
and  gave  him  active  treatment  for  several  weeks.  He  had  to  pay 
him  more  for  this  short  course  than  he  had  been  willing  to  pay 
me  for  all  those  years  he  was  with  me.  I  saw  him  some  time  later. 
He  told  me  the  "stomach  specialist  was  no  good."  Just  then  he 
was  taking  treatment  of  a  country  doctor  who  had  advised  him  to 


DYSPEPSIA.  161 

try  a  new  kind  oi'  mineral  water;  he  was  feeling  better  under  its 
use.  Some  people  prefer  to  take  nasty  tasting  medicines  and  min- 
eral waters  rather  than  live  under  good  air  conditions.  One  won- 
ders how  long  they  will  hold  out. 

A  middle-aged  woman  living  in  the  heart  of  the  city  on  a  very 
spit  dusty  street,  in  fact  over  a  saloon,  came  to  me,  accompanied 
by  her  husband,  for  a  preliminary  consultation.  At  the  time  I 
had  more  cases  than  I  wanted  and  to  accept  a  new  case  was  a  seri- 
ous matter.  Rather  than  give  superficial  attention  I  would  rather 
not  have  her  as  a  patient.  To  get  at  the  bottom  of  her  ill  health 
and  its  causes  would  probably  require  considerable  time.  But  one 
question  led  to  another  and  I  learned  much  regarding  her  illness, 
her  ancestry  and  the  surroundings  under  which  she  lived.  I  came 
to  the  conclusion  she  was  a  dust  victim  and  I  decided  to  accept 
her,  merely  to  see  whether  the  supposition  would  be  verified.  I 
investigated  as  fully  as  I  thought  necessary  and  then  explained 
what  I  thought  was  the  cause  of  her  attacks  and  continued  ill 
health.  Her  case  came  under  the  head  of  chronic  dyspepsia  or 
chronic  catarrhal  gastritis,  an  affection  that  has  a  large  and  varied 
number  of  symptoms. 

The  patient  entered  into  the  spirit  of  the  investigation  and 
watched  herself  and  the  conditions  under  which  she  lived.  In  a 
short  time  she  was  satisfied  that  her  ill  health  and  recurrent  at- 
tacks were  dependent  on  dust  influences  and  largely  preventable, 
but  not  wholly  so.  She  now  spent  most  of  her  time  in  the  kitchen, 
this  being  in  the  rear  of  a  very  long  building,  opening  on  to  the 
yards  of  others,  with  plants  and  trees,  and,  with  the  wind  coming 
from  the  west,  making  air  conditions  quite  favorable.  It  was  the 
front  of  the  house  and  hallway  with  air  coming  up  the  hallway 
that  was  to  be  avoided. 

To  show  how  matters  work  out  at  times  and  how  patients  differ 
I  might  refer  to  a  little  incident  which  occurred  at  a  Fourth  of 
July  celebration,  held  in  a  little  park  at  the  edge  of  town.  The 
day  was  a  fine  one  but  in  the  afternoon  a  thunderstorm  came  up 

Hi] 


162  DUSTY    AIR    AND    ILL    HEALTH. 

suddenly  and  everybody  rushed  into  the  large  barn-like  pavilion. 
My  patient  saw  the  storm  coming  and  was  in  a  quandary.  She 
looked  into  the  pavilion  The  air  was  very  dusty,  said  she  could 
smell  and  taste  the  dust,  it  was  so  thick.  She  knew  what  would 
happen  if  she  went  into  it.  She  went  around  to  the  east  side  of 
the  building  and  noticed  that  the  roof  was  overhanging.  She  rea- 
soned that  if  she  stood  on  the  east  side  she  would  escape  getting 
wet  ami  by  keeping  out  of  the  dust  avoid  getting  one  of  her  dis- 
turbed stomach  attacks  with  severe  headaches  and  prostration. 
Her  reasoning  was  good;  she  did  escape. 

Another  patient,  the  one  referred  to  on  p.  153,  was  also  pres- 
ent at  this  celebration ;  she  was  undecided  what  to  do  when  the 
storm  came  up.  She  knew  if  she  went  into  the  pavilion  she  would 
get  sick,  while  if  she  stayed  out  her  new  summer  dress  and  hat 
would  be  ruined.  She  went  in  with  the  crowd,  and  as  a  conse- 
quence had  a  severe  attack. 

During  the  same  week  another  one  of  my  patients  came  in  to 
report.  She  had  also  been  at  the  park  and  went  indoors,  she  had 
a  severe  attack  (in  this  case  of  membranous  catarrh  of  the  intes- 
tines). 

The  next  time  the  patient  here  under  discussion  came  in,  I 
told  her  about  these  two  and  how  they  suffered.  She  said,  "Now 
wasn't  I  smart  that  I  thought  of  staying  out  of  the  rain  and  stay- 
ing out  of  the  dusty  air  too?"  When  I  told  one  of  the  other  two 
patients,  the  farmer's  maid,  about  this  incident,  she  remarked, 
•'Now  why  didn't  I  think  of  that?"  Perhaps  needless  to  say  on 
subsequent  occasions  she  did  think  of  it. 

At  times  one  meets  retired  farmers  who  have  always  led  a 
laborious  life  and  who  think  to  end  their  days  quietly  and  peace- 
fully by  removing  to  town,  perhaps  to  live  with  a  son  or  daughter. 
But  they  quickly  complain  of  ill  health,  perhaps  die  in  a  short 
time.  They  spend  too  much  time  in  the  heart  of  the  city  and  get 
more  infection  than  the  body  can  get  rid  of.  A  physician  can 
greatly  benefit  some  of  these  individuals  if  they  apply  in  time. 


DYSPEPSIA.  163 

An  industrious  farmer  with  one  grown  daughter  lost  his  wife 
and  then  suddenly  tired  of  country  life  and  decided  to  move  to 
town.  He  had  saved  enough  to  pass  his  days  comfortably  but  like 
most  men  he  was  open  to  any  little  job  or  "chores"  that  would 
bring  in  something.  He  helped  his  neighbors  in  their  garden 
work,  repaired  fences  and  barns,  did  little  odd  jobs  about  the 
house,  cleaned  carpets  and  assisted  at  moving.  Naturally  with 
more  or  less  idle  time  he  spent  considerable  time  down  town  on 
street  corners.  He  got  along  fairly  well  during  the  open  door 
season  but  the  moment  cold  weather  arrived,  when  dust  was  no 
longer  sterilized  by  the  bright  rays  of  the  sun,  he  began  to  com- 
plain. 

Often  a  physician  is  compelled  to  spend  a  lot  of  time  in  inves- 
tigating and  ruling  out  the  presence  of  possible  diseases,  and  es- 
pecially in  cases  of  the  kind  here  under  discussion,  cancer  of  the 
stomach.  This  patient  wondered  whether  he  did  not  have  some- 
thing of  the  kind.  But  in  the  light  of  his  history  I  did  not  deem 
it  necessary  to  make  any  stomach  examination.  I  explained  what 
I  thought  was  at  the  bottom  of  his  ill  health  and  that  with  care 
it  would  disappear,  but  if  not  there  would  be  time  to  investigate 
more  fully.    All  he  needed  was  good  advice. 

Another  widowed  farmer  came  to  town  to  live  with  a  married 
daughter  after  renting  out  his  farm.  He  was  not  accustomed  to 
city  life,  reacted  constantly,  had  dyspepsia  and  constipation.  Said 
he  had  "tried  everything,"  tried  doctors  and  patent  medicine 
and  of  course  dieting  in  his  attempt  to  get  back  the  health  he  had 
had  on  the  farm. 

He  was  ready  to  have  his  stomach  examined  but  I  deemed  this 
unnecessary  in  the  light  of  his  history — but  I  did  propose  "health 
supervision,"  to  have  him  report  once  a  week.  He  soon  saw  that 
he  "would  have  to  make  it  a  business  to  keep  well  in  the  city," 
while  it  "was  no  trouble  at  all  to  keep  well  in  the  country"  and 
then  he  decided  to  go  back  to  the  country. 

Perhaps  the  most  pathetic  cases  the  practicing  physician  meets 
are  fellow-physicians  in  ill  health  who  have  had  all  sorts  of  diag- 


164  DUSTY  AIR   AND   IT.L   HEAtTfl. 

noses  and  finally  come  to  believe  in  none,  and  yet  are  all  the  time 
expecting  the  worst.  I  recall  a  physician  in  middle  life,  really  in 
his  best  years,  who  bad  retired  to  the  country  after  years  of  ill 
health  in  a  small  city.  He  regarded  his  "case"  as  peculiar,  as 
obscure  and  atypical.  The  fear  of  cancer  of  the  stomach  was  con- 
stantly present,  with  every  recurrent  attack  of  deranged  stomach. 
On  getting  his  history  and  making  a  brief  examination,  I  gave  him 
my  opinion — in  the  light  of  cases  here  cited.  The  explanation 
appealed  to  him  and  he  soon  verified  the  idea  of  dust  infection. 
He  again  took  up  practice.  He  now  knows  how  to  guard  himself 
and  he  keeps  out  of  the  dust,  including  dust  in  neglected  doctors' 
offices  where  he  used  to  loaf.  I  have  no  doubt  he  is  the  "best 
stomach  specialist"  in  his  city — if  the  people  only  knew  it. 

Now  I  do  not  want  to  be  understood  as  minimizing  the  impor- 
tance of  food,  of  diet.  It  is  an  important  matter ;  large  books  have 
been  written  regarding  the  subject.  And  yet  there  is  a  diversity 
of  opinion  on  the  relative  importance  of  a  high  or  low  protein 
diet,  on  the  value  of  a  vegetable  dietary,  and  even  to  what  extent 
vegetable  food  should  be  used  in  a  raw  state  or  cooked.  Opinions 
differ  regarding  the  best  drink — water,  milk,  coffee,  tea,  wine,  beer, 
all  have  their  advocates.  Water  drinkers  dispute  about  the  use  of 
water  at  meals  and  they  are  often  divided  regarding  the  proper 
temperature  of  drinking  water.  "When  doctors  disagree,  who  is  to 
decide?  There  are  many  things  that  we  have  to  find  out  for  our- 
selves, what  foods  or  drinks  agree  or  disagree  and  under  what 
conditions.  Similar  remarks  apply  to  all  other  essentials  of  life, 
clothing,  housing,  occupation.  What  agrees  with  one  may  disagree 
with  another  and  yet  there  are  certain  underlying  principles  which 
no  one  can  ignore.  We  all  have  some  general  idea  what  foods 
are  good  and  what  are  bad,  as  we  have  some  ideas  regarding 
proper  and  improper  housing.  All  I  am  trying  to  do  in  this  vol- 
ume is  to  call  attention  to  a  neglected  factor,  dust  in  the  air. 

The  world  advances;  there  are  higher  standards  everywhere. 
We  are  no  longer  satisfied  with  early  primitive  conditions,  but  as 
yet  we  are  not  particular  about  the  air  we  breathe.     Cities  have 


DYSPEPSIA.  165 

provided  themselves  with  good  water,  with  good  street  lighting, 
sewers,  houses,  etc.,  all  beyond  the  dreams  of  people  of  a  hundred 
years  ago.  This  of  course  is  as  it  should  he.  When  Agassiz  was 
professor  at  Harvard  he  made  great  efforts  to  build  up  the  Nat- 
ural History  department,  and  he  succeeded  so  well  that  other  pro- 
fessors complained  of  the  backwardness  of  their  own  departments ; 
some  even  tried  to  pull  his  down.  He  pointed  out  that  that  was 
not  the  proper  method;  instead  of  pulling  his  department  down 
they  should  try  to  raise  their  own.  When  cities  supply  the  people 
with  good  air  as  they  now  supply  good  water  we  may  look  for  a 
radical  improvement  in  general  health. 

Under  Kinds  of  Dust  there  was  a  mention  of  glass  dust.  One 
can  readily  understand  how  powdered  glass  may  be  injurious  to 
the  respiratory  tract.  We  need  only  consider  to  what  extent  glass 
is  used  in  daily  life  and  how  a  little  chip  of  glass  in  the  food  may 
injure  and  allow  infection  to  occur  or  it  may  even  perforate  the 
stomach  or  intestines.  Bits  of  bone  are  often  swallowed  and  pro- 
duce fear,  but  bone  readily  goes  into  solution  in  the  acids  of  the 
stomach ;  glass  on  the  other  hand  is  entirely  insoluble.  Then  too 
one  might  consider  the  sharp  pointed  silicious  diatoms  occurring 
in  some  drinking  water ;  they  may  be  a  factor  in  scarring  the  stom- 
ach and  especially  the  pylorus. 

Bits  of  glass  may  often  be  traced  to  unusual  sources.  The 
suburban  resident  who  has  a  little  garden  and  raises  chickens  on 
filled-in  soil  with  more  or  less  glass  must  be  careful  how  he  handles 
the  soil  with  his  hands  so  he  will  not  cut  himself.  His  chickens 
may  swallow  glass  and  his  teeth  may  find  it  later  when  eating  the 
chicken.  Root  plants  like  sweet  potatoes  in  pressing  the  soil  apart 
may  become  penetrated  by  bits  of  glass  and  here  again  the  teeth 
will  find  it  most  unexpectedly.  Properly  considered  broken  glass 
is  a  serious  menace. 


166  DUSTY   AIR   AND   ILL   HEALTH. 

CONSTIPATION. 

Connected  with  dyspepsia  is  constipation.  This  is  a  very  com- 
mon— what  shall  one  say,  disease,  minor  malady,  affection  or  symp- 
tom ?  Or  is  it,  at  least  at  times,  a  reaction  to  an  abnormal  environ- 
ment 1 

According  to  the  patent  medicine  men,  constipation  is  a  dis- 
ease, curable  by  their  particular  nostrums.  Physicians  generally 
regard  it  as  a  symptom;  it  is  only  exceptionally  that  it  can  be 
regarded  as  a  disease  and  can  be  cured  by  proper  treatment,  per- 
haps by  surgical  interference.  Commonly  it  is  a  symptom  that 
attends  all  sorts  of  bodily  disturbances,  especially  of  the  alimentary 
tract.  Constipation  is  so  common  that  the  general  practitioner 
rarely  studies  his  cases  sufficiently  to  discover  causes. 

That  constipation  may  be  due  to  dust  influences  did  not  dawn 
upon  me  for  a  long  time.  I  had  noticed  that  many  of  the  patent 
medicine  advertisements  seemed  dependent  on  air  conditions,  that 
they  were  most  common  during  the  closed  door  season.  I  noticed 
that  this  was  also  true  of  anti-constipation  remedies.  This  led  me 
to  study  cases  in  the  light  of  air  conditions,  and  I  soon  found  that 
in  many  constipation  is  largely  seasonal.  During  the  open  door 
season  there  is  little  complaint,  but  there  may  be  much  during  the 
closed  door  season. 

Cases  of  course  differ  greatly.  Some  individuals  must  make 
a  radical  change  in  their  mode  of  life  in  order  to  get  relief.  Others 
may  find  a  mild  laxative  taken  regularly,  say  at  night,  sufficient 
to  tide  them  over,  a  fact  recognized  by  the  patent  medicine  men 
who  advise  the  taking  of  a  dose  of  their  nostrum  at  night.  "It 
works  while  you  sleep." 

It  is  interesting  to  study  individuals  subject  to  constipation 
and  get  their  observations,  after  their  attention  has  been  called  to 
the  missing  factor,  in  the  light  of  what  is  written  in  this  volume. 
This  is  a  subject  that  I  must  dismiss  with  this  bare  mention. 

There  is  another  group  of  cases  that  must  be  dismissed  with  a 
brief  mention,  that  is  individuals  who  most  commonly  get  a  diag- 


DYSPEPSIA.  167 

nosis  of  "It's  the  liver,"  who  are  told  there  is  something  wrong 
with  the  liver  or  that  they  are  bilious. 

At  times  a  patient  is  told  he  has  or  had  gall-stones,  which  may 
or  may  not  be  true.  Under  certain  conditions  false  or  pseudo- 
gall-stones  are  passed,  indeed  some  patent  medicines  will  produce 
such,  leading  the  patient  to  believe  he  is  being  cured,  although  he 
will  continue  to  complain  as  usual,  or  on  the  return  of  the  closed 
door  season. 

Other  patients  are  told  they  have  appendicitis  or  are  threatened 
with  appendicitis.  The  surgeon  most  likely  gets  the  real  cases, 
but  some  are  not  cured  by  an  operation.  When  one  critically 
studies  such  cases,  and  keeps  them  under  observation  for  some 
time  one  may  learn  that  they  are  dust  victims. 

Old  chronics  who  have  made  the  rounds  in  time  come  to  attach 
very  little  importance  to  the  diagnoses  of  physicians;  they  think 
it  is  all  guess  work.  In  order  to  benefit  such  individuals,  assum- 
ing they  are  dust  victims,  one  must  explain  fully  and  get  them 
to  co-operate  and  observe,  and  then  certain  factors  may  stand  out 
very  plainly.  The  number  of  nostrums  advertised  in  the  news- 
papers for  curing  what  no  physician  can  cure  but  which  the  indi- 
vidual can  prevent  is  remarkable.  Our  Triad  of  National  Diseases 
and  their  varied  manifestations  furnish  a  ready  field  for  the  pat- 
ent medicine  man,  likewise  for  the  superficial  symptom-prescriber 
whose  medicines  may  not  be  on  a  higher  plane. 

Many  physicians  when  they  get  hold  of  a  new  case  promptly 
clean  him  out.  We  all  know  what  that  means,  indeed  there  is  a 
slogan,  Clean  Out,  Clean  Up,  and  Keep  Clean.  Perhaps  if  we  do 
the  second  thoroughly  there  will  be  little  need  for  the  first. 

Under  constipation  a  number  of  "little  practical  things"  could 
be  mentioned,  beginning  with  the  importance  of  having  a  regular 
hour  for  bowel  movements,  just  as  one  has  regular  hours  for  meals, 
and  the  importance  of  giving  the  bowels  time,  and  that  means  to 
have  a  decent  closet  where  one  does  not  desire  to  get  out  as  quickly 
as  possible.    No  prudent  man  will  rely  on  laxatives  and  cathartics. 

Curiously  enough  some  people  resent  questioning  about  the 


168  DUSTY    AIR    AND    ILL    HEALTH. 

bowel  movements  and  object  to  inspecting  the  feces  and  learning 
whether  they  are  normal  or  abnormal.  1  have  had  patients  who 
I  suspected  were  passing  intestinal  mucus  in  considerable  quan- 
tity, and.  perhaps  for  months  and  years,  but  who  had  never  ex- 
amined ;  some  had  had  physicians  who  prescribed  but  never  in- 
quired about  passing  mucus.  People  without  modern  closets  are 
of  course  at  a  great  disadvantage. 

Auto-Intoxication.  Within  the  last  few  years  people  have 
heard  more  or  less  about  auto-intoxication.  This  is  or  has  been  a 
popular  explanation  among  doctors.  The  term  refers  more  par- 
ticularly to  symptoms  or  conditions  produced  by  the  decomposi- 
tion of  food  in  the  intestinal  tract.  The  term  autotoxemia  is  also 
used,  which  might  be  translated  as  poisoning  one's  own  blood  on 
account  of  a  deranged  intestinal  tract.  The  young  doctor  fresh 
from  medical  school  is  apt  to  use  these  terms  instead'  of  the  older 
term  biliousness. 

During  my  second  year  here  an  old  farmer  from  an  adjoining 
county  came  to  me  complaining  of  stomach  trouble  and  constipa- 
tion. He  had  had  various  diagnoses,  among  them  the  common  ones 
of  "biliousness,"  "It's  the  liver,"  "a  touch  of  malaria,"  malaria, 
dyspepsia,  indigestion,  and  similar  common  explanations.  As  he 
did  not  complain  of  colds  I  did  not  regard  him  as  a  dust  victim 
and  advised  and  prescribed  as  a  physician  usually  does  in  such 
cases,  in  the  light  of  what  I  had  been  taught  and  what  is  given  in 
the  books.  I  tried  my  best  to  help  him  but  after  coming  in  a  few 
times  he  failed  to  report. 

Five  years  later  he  came  back  and  I  now  learned  that  he  had 
been  living  in  another  State  but  now  returned  to  his  old  home. 
He  now  knew  what  ailed  him,  "It's  auto-intoxication."  How  do 
you  know?  "That  is  what  my  son  told  me;  he  is  a  doctor  prac- 
ticing out  "West." 

Now  when  this  farmer  was  with  me  before  I  had  the  impression 
that  he  was  a  very  ignorant  man,  that  he  farmed  as  his  ancestors 
had  and  likely  planted  his  potatoes  "when  the  moon  was  right." 
I  now  questioned  and  found  this  was  actually  the  case.     Then 


DYSPEPSIA.  169 

1  wondered  to  what  extent  the  son  had  imbibed,  had  retained  or 
outgrown  such  ideas,  in  other  words  my  interest  was  transferred 
from  the  father  to  the  son.  The  son  attended  the  common  country 
schools  (and  we  all  know  what  they  teach),  and  then  he  went  to 
a  nearby  small  county-seat  high  school  where  more  or  less  ele- 
mentary science  is  taught,  and  then  to  medical  college — where  they 
teach  regarding  definite  diseases  rather  than  common  ill  health. 
1  could  not  resist  wondering  to  what  extent  knowledge  imbibed 
in  the  family  circle  still  influenced  him,  and  on  the  other  hand  to 
what  extent  his  medical  training  inclined  him  to  consider  every 
patient  afflicted  with  some  definite  disease. 

The  man's  ill  health  I  soon  found  was  due  to  loafing  in  town 
and  at  the  village  store.  The  data  I  got  from  him  did  not  amount 
to  anything,  but  I  continued  him  in  the  hope  that  I  would  get 
some  definite  details  regarding  his  physician  son. 

A  short  time  ago  in  discussing  one  of  my  former  patients  with 
a  physician  who  had  also  had  the  man  under  his  care,  he  men- 
tioned having  heard  that  his  present  physician  had  advised  some 
outlandish  mode  of  treatment.  When  I  expressed  my  surprise, 
he  said,  "I'll  bet  he  never  learned  that  in  medical  college."  He 
expressed  his  belief  that  that  was  something  he  had  learned  before 
becoming  a  medical  student.  More  recently  while  visiting  a  den- 
tist he  made  some  remark,  some  recommendation,  when  I  said,  I 
am  sure  you  never  learned  that  in  your  dental  college.  "Oh,  no, 
that  is  some  of  the  knowledge  current  among  the  people, ' '  adding, 
"We  doctors  like  all  the  rest  are  drawn  from  the  common  lot." 
This  is  a  profound  truth  that  we  often  forget.  It  is  difficult  to 
outgrow  some  things,  and  where  there  is  no  definite  knowledge  to 
the  contrary  a  physician  may  resort  to  methods,  to  modes  of  treat- 
ment, current  among  the  people. 

Biliousness  is  an  old  term  current  among  the  people.  Some 
old  physicians  still  use  it  and  even  young  men  may  use  it  in  mak- 
ing explanations  to  their  patients.  To  say  "You  are  bilious" 
usually  stops  further  inquiry.  People  think  they  know  what  is 
the  matter. 


170  DUSTY   AIR   AND   ILL    HEALTH. 

Biliousness  of  course  refers  to  bile  and  that  in  turn  to  the  liver. 
The  old  time  doctor  gave  mercury  to  stimulate  the  liver,  he  spoke 
of  getting  rid  of  bile  and  of  stimulating  the  liver;  he  noticed  that 
under  catharsis  his  patients  felt  better.  When  I  was  a  medical 
student  we  were  told  that  the  terms  biliousness  and  bilious  are 
unscientific  and  should  not  be  used.  As  a  matter  of  fact  one  rarely 
sees  them  in  scientific  literature. 

But  one  may  question  what  were  the  facts  underlying  such  a 
term,  such  an  explanation.  "What  kind  of  cases  were  they  to  which 
the  term  biliousness  applies?  Similarly  we  may  question  what 
sort  of  cases  are  included  under  the  term  auto-intoxication  ?  The 
old  time  doctor  purged  his  patients  with  mercury ;  the  doctor 
today  uses  a  variety  of  cathartics  and  laxatives  to  clean  out  the 
intestinal  tract  and  to  keep  the  bowels  open.  Is  the  following 
from  a  patent  medicine  advertisement  true? 

"Biliousness,  Auto-Intoxication.  Dr.  — 's  Laxative  Tablets  will 
almost  always  relieve  these  ailments  and  any  of  these  symptoms  should 
always  indicate  their  use. 

"Biliousness :  An  irritable  word  for  an  irritable  condition.  The  old 
idea  of  biliousness  is  the  modern  auto-intoxication  one  hears  about  so 
much  nowadays;  that  is,  there  is  an  absorption  of  toxins  (poisons)  from 
the  clogged  and  sluggish  bowels.  Everyone  seems  irritable  to  you  and  you 
probably  are  to  everyone  else.  You  just  feel  all  out  of  sorts.  Probably 
don't  eat  well,  sleep  well  or  feel  well.  You  are  being  poisoned  by  absorb- 
ing the  waste  from  your  body  that  should  be  evacuated. 

"When  in  this  condition  take  Dr.  — \s  Laxative  Tablets — the  quicker 
the  better.     Better  still,  take  them  in  time  and  avoid  this  condition." 

Such  an  advertisement  at  least  shows  that  the  patent  medicine 
men  are  constantly  adopting  the  newer  ideas  in  medicine  and  at- 
tempting to  show  that  in  spite  of  the  "advance  in  medicine" 
their  old  remedies  are  still  applicable. 

How  can  we  explain  the  rise  and  decline  of  just  such  adver- 
tisements, advertisements  relating  to  laxatives  and  cathartics  that 
are  so  common  during  the  closed  door  season  and  practically  dis- 
appear during  the  open  door  season  ?  I  am  giving  my  explana- 
tion.    I  wonder  if  others  have  a  better  one? 


DYSPEPSIA.  171 

DIFFERENTIAL  DIAGNOSIS.     RULING  OUT. 

One  of  the  most  important  duties  of  the  physician  is  to  make 
a  differential  diagnosis,  to  rule  out  diseases  and  narrow  the  in- 
quiry down  to  some  one  disease,  if  possible.  Failure  to  do  so  may 
result  in  serious  harm,  not  alone  to  the  individual  hut  to  the  com- 
munity. We  need  only  think  of  the  danger  to  a  whole  school  in 
the  failure  of  a  physician  to  properly  diagnose  diphtheria,  scar- 
let fever  and  other  acute  diseases  of  childhood,  of  the  danger  to 
a  community  from  the  first  case  of  Asiatic  cholera  or  bubonic 
plague. 

Although  good  air  can  do  no  harm  to  any  one  yet  in  some 
cases  that  may  be  the  least  that  the  physician  may  be  able  to  ad- 
vise. The  man  who  exhibits  symptoms  of  ill  health  may  be  found 
to  have  a  serious  disease  requiring  active  treatment,  perhaps  a 
surgical  operation,  as  in  cases  where  there  is  suppuration  and 
nature  seems  helpless ;  pus  in  the  chest  cavity  or  in  the  abdominal 
cavity  or  in  the  appendix  vermiformis  may  require  prompt  surgi- 
cal treatment.  Some  one  must  be  able  to  make  the  proper  diag- 
nosis and  some  one  must  know  just  what  to  do,  or  the  individual 
will  perish. 

One  of  the  commonest  diseases  that  must  be  ruled  out  in  throat 
and  chest  diseases  is  tuberculosis,  consumption.  In  advanced  cases 
this  is  easy,  in  early  cases  it  may  be  very  difficult,  the  individual 
may  have  to  be  kept  under  observation  for  some  time.  In  dis- 
eases of  the  alimentary  tract  cancer  must  constantly  be  ruled  out, 
and  here  again  it  may  be  difficult  to  recognize  early  stages.  Men 
who  specialize  are  naturally  supposed  to  do  more  thorough  work 
than  the  general  practitioner.  In  the  beginning  stages  of  a  dis- 
ease a  timely  operation  may  save  or  at  least  prolong  life ;  to  wait 
until  almost  any  one  can  make  a  diagnosis  means  an  early  fatality. 

The  timely  use  of  the  proper  remedy,  as  antitoxin  in  diphtheria 
or  quinine  in  malaria,  may  prevent  death  or  at  least  much  suffer- 
ing and  sickness.  In  speaking  of  suffering  we  should  not  forget 
that  the  anguish  of  the  parents  may  be  much  greater  than  the 


172  DUSTY    AIR    AND    ILL    HEALTH. 

suffering  of  the  child;  and  on  the  other  hand  children  may  suffer 
on  account  of  the  illness  of  the  parent.  One  need  not  be  sick  to 
suffer. 

Is  it  necessary  to  say  that  the  best  general  advice  that  can  be 
given  the  people  in  case  of  ill  health  or  sickness  or  disease  is  to 
consult  a  good  physician,  still  better  have  a  consultation  of  several? 
A  physician  constantly  dealing  with  sick  people  may  be  considered 
an  expert  in  such  matters,  he  knows  more  than  those  who  make 
no  study  of  diseases.  Is  it  necessary  to  add  that  an  old  experienced 
chronic  may  have  a  fund  of  knowledge  learned  through  bitter 
experience  that  makes  him  a  rival  of  the  physician  in  that  par- 
ticular kind  of  ill  health?  He  is  the  man  vitally  interested.  He 
may  know  much  more  than  the  young  doctor  who  tries  to  make 
light  of  his  complaints. 

The  number  of  symptoms  that  attend  a  disease  is  variable, 
some  are  essential  symptoms  and  others  secondary,  they  may  be 
present  or  absent.  Much  depends  on  environment.  The  "disease 
pictures"  given  in  the  textbooks  are  mainly  based  on  city  cases, 
only  too  often  on  city  hospital  cases,  in  other  words  on  poor  peo- 
ple who  are  sent  to  city  hospitals.  The  country  doctor  practicing 
among  a  different  set  of  patients  may  find  few  "typical  cases"  but 
any  number  of  "atypical"  ones;  some  of  the  common  symptoms 
in  city  patients  may  be  absent.  Consumptives  may  exhibit  few 
symptoms  in  good  air,  likewise  the  man  with  typhoid  fever  and 
the  child  with  scarlet  fever. 

CANCER   OF   THE    STOMACH. 

Although  the  active  cause  of  cancer  is  still  unknown  its  course  is  so 
definite  that  it  is  regarded  as  a  specific  disease.  There  are  different  kinds 
of  cancer.  Any  part  of  the  hody  may  be  attacked,  from  the  skin  to  the 
internal  organs. 

Cancer  of  the  stomach  is  rather  common.  Nausea  and  retching  and 
vomiting  may  at  times  be  seemingly  uncontrollable  and  yet  under  good  air 
conditions  these  may  be  almost  wholly  absent.  Several  years  ago  I  had 
under  observation  four  cases  of  cancer  of  the  stomach  at  about  the  same 
time,  living  under  different  surroundings,  which  markedly  showed  the 
influence  of  air  conditions.  I  shall  make  a  brief  mention  of  the  cases 
from  memory,  without  going  into  details. 


DYSPEPSIA.  173 

Mrs.  — .  Middle-aged  housewife  living  on  the  edge  of  the  business 
district,  where  great  clouds  of  dust  blow  about.  Evidences  of  cancer  of 
the  stomach  were  well  marked  when  I  first  saw  her.  There  was  constant 
retching  and  almost  uncontrollable  vomiting.     She  did  not  last  long. 

Mrs.  — .  Had  always  lived  on  a  farm  until  her  present  illness  when 
she  removed  to  town  to  live  with  a  married  son,  just  beyond  the  business 
district  where  she  got  the  dust  from  the  heart  of  the  city.  Almost  imme- 
diately there  were  severe  attacks  of  retching  and  vomiting.  I  soon  diag- 
nosed cancer  of  the  stomach,  the  diagnosis  being  verified  by  the  course  of 
the  disease  and  death.  On  windy  days  with  clouds  of  dust  on  the  street, 
there  was  much  nausea,  retching  and  vomiting. 

Mr.  — .  A  well-to-do  farmer  with  a  good  home  heated  by  hot  air. 
Hot  air  means  a  constant  current  of  outdoor  air  coming  into  the  house. 
He  gave  a  history  of  obscure  stomach  disturbance  that  at  first  was 
puzzling.  He  would  get  along  for  a  week  or  two  with  scarcely  any  symp- 
toms and  then  there  would  be  attacks  of  nausea  and  vomiting.  I  soon 
discovered  that  as  long  as  he  remained  on  the  farm  he  had  practically  no 
difficulty  but  that  after  a  visit  to  town  the  stomach  would  be  disturbed. 
When  he  came  to  me  the  stomach  disturbances  were  so  marked  that  I 
at  once  suspected  cancer.  He  did  not  take  kindly  to  the  idea  of  remaining 
away  from  town,  which  I  hoped  would  reduce  retching  and  vomiting  to  a 
minimum.  Finally  I  had  to  tell  him  that  I  could  do  very  little  for  him 
and  then  he  drifted  into  the  hands  of  a  physician  who  without  knowing 
what  the  difficulty  was  promised  to  cure,  or  at  least  benefit  him  greatly, 
and  had  him  come  in  town  frequently,  only  to  aggravate  the  difficulty, 
and  he  soon  became  bedfast.  In  a  short  time  he  died.  On  account  of 
the  discrepancy  of  opinion  among  physicians  the  family  had  a  post 
mortem  and  cancer  was  found. 

Mr.  — .  Farmer  who  lived  in  town  from  where  he  supervised  his 
farms.  He  was  a  dust  victim  with  occasional  disturbances  of  the  stomach. 
Finally  the  disturbance  became  so  marked  that  the  presence  of  cancer  was 
suspected,  and  when  one  day  "coffee  ground  vomit"  appeared  a  definite 
diagnosis  was  made.  In  the  course  of  time  the  stomach  no  longer  re- 
tained food  and  feeding  by  enemas  was  resorted  to.  The  man  lived  on 
a  hill  overlooking  town,  under  almost  ideal  air  conditions,  and  to  see 
him  lying  on  a  couch  before  the  open  window  one  would  scarcely  suspect 
that  he  had  a  life-destroying  disease,  there  were  no  evident  symptoms. 
Then  toward  fall  dry  weather  set  in  and  the  town  in  the  valley  was  over- 
hung by  a  smog  cloud.  The  height  varied,  at  times  being  low  and  then 
again  rising  so  that  only  the  highest  church  steeple  would  be  visible. 
Looking  out  over  the  valley  one  would  not  suspect  the  presence  of  a  city 
at  all. 

Such  conditions  appear  almost  unbelievable.  Just  how  much  infection 
was  present  in  the  air  is  of  course  difficult  to  determine.  But  the  dust 
and  smoke  cloud  was  irritating  to  mucous  membranes.     It  was  quickly 


174  DUSTY   AIR   AND   ILL   HEALTH. 

noticed  that  whenever  it  readied  his  open  window  and  came  into  the 
house  there  was  not  only  bronchial  Irritation  with  cough  hut  also  marked 
nausea  and  retching  and  vomiting  of  mucus.  A  rainstorm  brought  relief. 
The  patient  gradually  failed.  Here  too  a  post  mortem  verified  the  diagno- 
sis of  cancer  of  the  pylorus,  but  so  small  in  size  that  it  could  not  be  diag- 
nosed through  the  abdominal  walls.1 

MEMBRANOUS  CATARRH  OP  THE  INTESTINES. 

One  type  of  dust  infection,  or  Coniosis,  rather  frequent  when 
looked  for  among  chronics,  is  characterized  by  the  passing  of  more 
or  less  intestinal  mucus,  often  in  the  form  of  strings  or  ribbons, 
and  with  a  long  list  of  symptoms.  There  may  or  may  not  be  a 
mucus  formation  in  the  respiratory  tract.  Because  some  dust  vic- 
tims do  not  have  colds  and  catarrh  one  may  be  misled  regarding 
dust  influences.  Some  of  my  own  early  cases  I  wholly  misunder- 
stood. This  of  course  is  again  an  admission  of  ignorance,  but  T 
was  no  more  ignorant  than  those  about  me,  who  like  myself  had 
not  been  taught  about  dust  influences. 

One  of  my  earliest  patients  undoubtedly  comes  under  this  type 
of  dust  victims.  She  complained  of  a  large  number  of  symptoms, 
such  as  one  finds  among  women  who  are  commonly  called  "hys- 
terical. ' '  I  myself  was  inclined  to  label  her  as  hysterical,  that  her 
complaints  were  largely  "imaginary."  That  she  had  intestinal 
mucus  and  that  she  was  a  dust  victim  I  did  not  at  all  suspect. 
I  found  this  out  later.  Unfortunately  she  was  so  disgusted  be- 
cause I  did  not  benefit  her  that  she  never  returned.  Even  in  some 
of  my  early  cases  that  had  mucus  formation  in  nose  and  throat, 
in  other  words  catarrh,  I  did  not  suspect  dust  influences.  But 
when  I  began  to  notice  that  good  air  benefits  catarrh  victims  I 
suspected  that  it  might  be  good  for  others  who  have  mucus  for- 
mation elsewhere. 

In  the  previous  chapter  I  spoke  of  Kinds  of  Colds.    A  similar 


1  In  such  ca3cs  the  value  of  surgery  must  be  considered.  Just  how  much  benefit  is  to  be  obtained 
through  a  timely  operation  is  of  course  a  problem. 

Since  the  advent  of  "surgical  cleanliness"  surgery  has  made  wonderful  progress.  Often  "exploratory 
operations"  are  indicated;  the  internal  condition  may  or  may  not  warrent  operations  on  the  cancer. 
Naturally  the  man  who  constantly  operates  has  a  greater  degree  of  skill  than  the  occasional  operator. 
Unfortunately  the  big  city  surgeon  often  demands  an  exorbitant  fee — but  perhaps  not  excessive  after 
all  when  we  consider  the  time  he  spends  away  from  home,  hours  in  which  he  might  have  performed 
several  operations  in  his  own  city. 


DYSPEPSIA.  175 

explanation  could  be  made  regarding  attacks  of  membranous  ca- 
tarrh of  the  intestines,  likewise  of  dyspepsia,  particularly  acute 
attacks  of  indigestion  accompanied  by  much  mucus. 

Although  membranous  catarrh  of  the  intestines  is  rather  fre- 
quent among  old  chronics,  yet  the  books  have  very  little  to  say 
and  as  a  rule  they  are  pessimistic  regarding  treatment. 

Case  Report.  Among  my  early  patients  was  a  middle-aged 
Irishman  who  came  to  this  country  while  still  a  boy.  He  promptly 
got  "American  Catarrh."  He  looked  upon  it  as  a  disagreeable 
and  necessary  evil,  rather  than  as  a  disease.  In  the  course  of  a 
few  years  the  mucus  formation  travelled  down  into  the  stomach 
and  then  he  had  "American  Dyspepsia."  This  soon  annoyed  him 
to  such  an  extent  that  he  began  to  consult  the  doctors;  he  had  too 
much  sense  to  try  patent  medicines.  He  came  to  me  at  a  time 
when  the  mucus  formation  apparently  was  travelling  into  the  is- 
testinal  tract  but  it  took  me  some  time  to  understand  the  case  and 
its  relationship  to  air  conditions.  He  had  an  occupation  that  ex- 
posed him  to  much  infected  dust.  In  the  course  of  a  few  years 
this  intestinal  mucus  formation  became  very  marked  and  then  he 
had  all  sorts  of  symptoms.  At  first  when  working  for  others  he 
had  no  business  worries  but  these  appeared  when  he  went  into 
business  for  himself.  At  one  time  when  his  business  was  seriously 
threatened  he  became  sleepless  and  lost  his  appetite  and  almost 
any  physician  would  regard  him  as  a  case  of  "nervous  prostra- 
tion." Then  the  crisis  passed  and  the  nervous  symptoms  dimin- 
ished and  again  he  was  an  "old  chronic"  with  mucous  membranes 
that  gave  off  a  lot  of  mucus,  very  freely  during  the  closed  door 
season,  less  so  during  the  open  door  season  and  still  less  on  lead- 
ing an  outdoor  life  for  a  while. 

One  day  he  spoke  about  the  healthy  color  he  had  when  he  first 
came  here,  and  how  Irish  girls  have  a  healthy  color  and  how  soon 
they  lose  it  and  become  sallow.  He  noticed  the  same  thing  among 
Germans.  After  he  became  convinced  that  air  conditions  played 
a  very  important  role  in  his  own  ill  health,  he  saw  why  there  is 
loss  of  color  on  coming  to  this  country. 


176  DUSTY   AIR   AND   ILL   HEALTH. 

Case  Report.  Here  is  a  brief  case  report  taken  from  a  paper 
previously  mentioned.  Dust,  a  Neglected  Factor  in  III  Health. 
At  that  time  I  did  not  realize  that  there  was  a  typq  of  dust  vic- 
tims in  which  the  intestinal  mucus  is  the  chief  characteristic.  At 
that  time  I  did  not  even  inquire  about  the  passage  of  bowel  mu- 
cus; indeed  many  patients  are  not  aware  of  it  on  account  of  closet 
arrangements. 

Cask  III. — Mrs.  II..  a  housewife  of  about  26,  lives  in  the  eastern  resi- 
dence portion  of  the  city;  she  has  the  appearance  of  being  "run  down." 
She  came  to  ine  early  in  March  with  a  history  of  various  disturbances; 
pain  in  the  hack,  wandering  pains  in  the  body,  beadache,  deranged  stomach 
and  bowels  with  a  discharge  of  much  mucus  at  times.  Has  a  sickly  yellow 
color.  Says  she  has  had  all  sorts  of  experiences  with  physicians  and  was 
now  almost  discouraged.  I  suggested  a  systematic  examination,  to  which 
she  agreed,  with  the  following  results :  Bodily  development  good ;  except- 
ing tenderness  in  the  chest  and  abdomen  and  along  the  spine,  the  physical 
examination  was  practically  negative.  Red  blood  cells  reduced  to  3,800,- 
000;  hemoglobin  to  60%.  Gastric  fluid,  after  a  test-meal,  contained  much 
mucus ;  small  amount  of  HC1  present,  also  lactic  acid,  yeast,  and  some 
pus.  Sputum  mainly  mucus  with  some  purulent  matter  full  of  bacterial 
life,  but  no  tubercle  bacilli.  Urine  very  concentrated;  acidity  and  phos- 
phates high.  Pulse  tracing  normal,  but  nervous  and  influenced  by  the 
respiration.  I  should  have  stated  before  that  this  patient  wore  a  long 
trailing  dress  and  came  down  town  frequently. 

After  further  questioning  the  patient,  and  after  a  study  of  the  re- 
sults of  the  examinations,  she  was  advised:  1.  To  shorten  her  dresses — 
to  keep  them  off  the  ground.  2.  To  stay  at  home ;  if  compelled  to  go  down 
town,  to  go  only  on  wet  days.  3.  To  use  water  more  freely  and  to  reduce 
the  amount  of  animal  food.  4.  For  the  excessive  amount  of  mucus  in 
the  throat  and  stomach,  she  was  advised  to  gargle  with  a  very  dilute  salt 
and  baking  soda  solution,  and  to  drink  half  a  glass  full,  hot,  half  an  hour 
before  meals.  5.  She  was  placed  on  a  laxative  organic  iron  preparation, 
to  be  used  after  meals,  and  in  sufficient  amount  to  keep  the  bowels  open. 

This  patient  began  to  improve  at  once,  the  bodily  functions  became 
normal,  color  came  to  the  cheeks,  and  the  former  disagreeable  symptoms 
disappeared.  The  only  time  she  complains  is  during  the  prevalence  of 
dusty,  windy  weather,  and  then  only  of  the  wandering  pains.  The  ex- 
cessive secretion  of  mucus  from  the  respiratory  and  alimentary  tracts  has 
almost  ceased. 

Recently  it  was  explained  to  her  more  fully  how  the  dust  had  and 
still  does  affect  her,  and  this  has  made  her  more  cautious;  she  is  now 
firmly  convinced  of  the  influence  of  infected  dust. 


DYSPEPSIA.  177 

It  will  be  noticed  that  this  statement  occurs:  Claims  she  has 
had  all  sorts  of  experiences  with  physicians;  is  now  almost  dis- 
couraged. Such  or  similar  remarks  apply  to  many  of  these  cases. 
This  is  a  rather  painful  subject;  when  one  goes  into  details  phy 
sicians  regard  it  as  a  reflection  on  the  profession.  Much  can  of 
course  be  said  but  after  all  the  one  great  reason  people  get  routine 
attention  and  no  special  investigation  is  that  they  are  unwilling 
to  pay  the  physician  for  the  time  it  takes  to  make  the  investiga- 
tions and  advise  fully.  Good  advice  implies  investigation  and 
time  must  be  paid  for.  That  many  physicians  are  not  students 
must  of  course  be  self-evident.  One  may  ask,  How  are  people  to 
know  who  are  conscientious  and  studious  physicians?  Perhaps  if 
people  received  more  instruction  in  the  common  schools,  had  a 
better  knowledge  of  their  own  body  and  of  their  surroundings, 
they  could  judge.  People  ought  to  have  sufficient  education  to 
enable  them  to  select  a  family  physician  properly.  Perhaps  if  the 
people  demanded  a  higher  standard  there  would  be  fewer  incom- 
petents. On  the  other  hand  we  must  not  forget  that  the  standards 
may  be  so  high  that  poor  people  can  not  afford  a  well-trained 
physician  and  that  perforce  they  are  compelled  to  resort  to  the 
uneducated  and  unlegalized  practitioners.  The  practice  of  med- 
icine is  after  all  a  business  and  the  legalized  practitioners  have 
all  sorts  of  competitors. 

The  number  of  symptoms  accompanying  eases  of  membranous 
catarrh  of  the  intestines  is  large.  I  shall  shortly  refer  to  them. 
They  vary  with  the  season  of  the  year,  with  surroundings  and 
prudence.  People  in  the  heart  of  the  city  may  have  a  large  num- 
ber, while  others  in  the  suburbs  may  have  comparatively  few. 
Often  one  meets  people,  patients,  who  complain  that  in  spite  of 
"being  careful,"  of  being  very  careful,  or  being  "exceedingly 
careful, ' '  they  still  suffer.  They  do  not  know  how  to  guard  them- 
selves. As  a  rule  such  patients  have  had  all  sorts  of  advice  re- 
garding the  influence  of  diet.  At  the  same  time  most  of  these 
patients  have  been  overdrugged.     Treatment  often  is  heroic,  es- 

[121 


178  DUSTY   AIR   AND   ILL  HEALTH. 

pecially  by  injecting  large  amounts  of  fluid  into  the  lower  bowel. 
What  most  of  these  people  need  is  good  air  advice,  with  all  that 
that  implies. 

Case  Report.  A  middle-aged  woman,  while  greatly  depressed 
on  account  of  a  great  sorrow,  lost  her  immunity  to  bad  air  and 
became  quite  susceptible,  acute  attacks  manifesting  themselves  by 
the  passage  of  large  quantities  of  intestinal  mucus.  During  the 
closed  door  season  mucus  was  present  more  or  less  constantly.  Her 
family  physician  was  one  who  believed  in  giving  lots  of  medicine 
but  as  she  was  getting  no  better  she  finally  rebelled.  I  promptly 
explained  that  her  affection  properly  considered  was  not  a  disease 
at  all,  only  a.  reaction  to  an  unsanitary  environment,  After  getting 
the  facts  in  the  case,  1  fully  advised  her  regarding  the  sources  of 
infection  and  how  to  avoid  them.  The  simple  advice  to  remain  in 
good  air  aided  by  a  little  medication  reduced  the  disturbance  to 
a  minimum.  There  were  several  acute  attacks  following  exposure, 
emphasizing  the  fact  that  she  was  a  dust  victim.  For  a  year  there 
was  practically  no  difficulty.  Then  she  was  persuaded  by  a  neigh- 
bor to  attend  a  good  opera,  the  plea  being  made  that  "this  is  a 
fine  opera,  attended  by  the  best  people  of  the  town  only."  She 
went,  forgetting  that  the  night  before  the  "worst  people"  in  town 
attended  the  vaudeville,  leaving  the  floor  sadly  soiled  with  all 
sorts  of  infection.  She  had  difficulty  in  staying  out  the  perform- 
ance and  then  had  such  a  severe  attack  that  she  almost  perished. 
Perhaps  needless  to  say  after  such  an  occurrence  people  are  ex- 
ceedingly careful.  "Exceedingly  careful"  means  living  within 
one's  limitations.  This  is  something  that  must  be  learned.  Often 
it  is  a  dear  lesson.  When  a  physician  has  such  a  patient  under 
observation  for  a  number  of  years  and  notices  how  certain  causes 
produce  an  effect,  he  is  apt  to  have  some  decided  views  and  to 
speak  rather  dogmatically  to  patients  who  react  similarly. 

It  has  already  been  mentioned  that  many  consider  climate  as 
the  cause  of  colds  and  catarrh,  while  others  consider  food  as  the 
cause  of  dyspepsia  and  constipation      As  a  matter  of  fact  all  sorts 


DYSPEPSIA.  179 

of  causes  are  assigned  in  cases  of  ill  health — often  all  but  the  right 
one.  Bad  air  of  the  kind  indicated  in  this  volume  is  very  common 
in  our  country  and  it  should  be  one  of  the  first  causes  to  be  ruled 
out.  And  yet  on  inquiry  among  patients  it  is  remarkable  to  find 
how  little  attention  is  given  to  this  cause. 

One  of  my  elderly  patients  (a  dust  victim  who  improved  under 
good  air  advice)  had  had  all  sorts  of  advice  and  was  given  all 
sorts  of  reasons  for  her  ill  health.  Every  physician,  and  she  con- 
sulted only  good  ones,  thought  it  was  necessary  to  advise  her  re- 
garding diet.  She  seemed  to  think  physicians  believed  her  com- 
plaints were  due  mainly  to  what  she  eats.  She  herself  thought 
they  were  principally  due  to  clothing,  to  underwear,  being  too 
thinly  or  too  heavily  dressed.  When  to  put  on  or  when  to  take 
off  underwear  was  one  of  the  great  problems  of  her  life.  Then 
she  had  an  idea  that  the  matter  of  baths  was  an  important  one, 
when  and  how  often  and  at  what  temperature  to  take  them.  Old 
people  are  often  set  in  their  ideas  and  it  is  hard  to  teach  them; 
they  will  revert  to  their  old  beliefs  over  and  over.  It  was  difficult 
to  teach  her  that  the  thing  she  had  to  guard  against  was  what  she 
inhaled,  that  all  other  factors  were  of  minor  importance. 

"We  still  find  physicians  who  have  all  sorts  of  ideas  regarding 
the  importance  of  material  out  of  which  underwear  should  be 
made,  wool,  silk,  linen,  cotton,  open  or  close  weave,  and  even  its 
color.  After  one  has  studied  a  large  number  of  cases,  one  is  apt 
to  come  to  the  conclusion  to  give  the  simple  advice,  Live  simply, 
breath  good  air  and  dress  for  comfort. 

It  always  takes  a  new  doctor  in  town  some  time  to  become  es- 
tablished. But  in  time  he  may  find  more  applicants  than  he  can 
serve  and  he  is  apt  to  raise  his  requirements.  He  will  no  longer 
accept  every  Tom,  Dick  and  Harry  who  applies.  Rather  than  give 
superficial  service  he  prefers  not  to  give  any. 

As  a  student  of  ill  health,  my  own  practice  and  methods  of 
course  differed  from  the  ordinary.  As  soon  as  I  had  more  appli- 
cants than  I  desired  I  raised  the  requirements.  I  accepted  appli- 
cants on  the  promise  that  they  would  keep  a  daily  record  of  how 


180  DUSTY    AIR    AND   ILL    HEALTH. 

they  felt  and  what  they  did  and  to  report  now  and  then,  the  fre- 
quency depending  on  the  urgency  of  the  ease.  A  little  later  I  ex- 
pected a  brief  autobiographical  account,  including  family  history. 
Such  a  requirement  naturally  excluded  those  who  ordinarily  come 
for  "a  little  medicine."  On  the  other  hand  it  brought  those  who 
were  determined  to  make  the  matter  of  getting  well  a  business. 
Now  men  must  work  as  a  rule,  they  can  not  make  any  decided 
change  in  their  daily  life.  They  may  prefer  a  physician  who 
merely  gives  a  lot  of  medicine  and  does  not  demand  any  change 
in  his  occupation,  in  home  environment,  or  mode  of  life.  On  the 
other  hand  women,  especially  those  who  have  more  or  less  leisure, 
can  usually  live  up  to  advice  and  for  this  reason  they  may  be 
more  desirable  as  patients,  and,  one  may  add,  as  fellow-students. 

How  are  we  to  learn  about  chronic  ill  health  and  its  fluctua- 
tions? Why  do  we  feel  better  one  day,  one  week,  and  worse  the 
next  ?  What  is  the  cause  of  ups  and  downs  ?  Similarly  we  may  ask 
about  the  wind  and  weather  changes.  We  commonly  hear  it  said 
that  there  is  no  accounting  for  wind  and  weather  and  yet  the 
weather  service  is  able  to  predict  many  things.  The  reason  is 
that  men  have  kept  daily  records  for  years  and  years  and  from 
these  records  certain  deductions  can  be  made.  If  more  people 
kept  a  record  of  their  ill  health  and  an  account  of  their  daily  life 
perhaps  the  student  of  ill  health  could  likewise  arrive  at  some 
definite  conclusions  and  make  predictions,  not  only  for  the  life  of 
a  particular  individual  but  also  regarding  the  lives  of  all. 

At  first  sight  it  would  seem  inadvisable  to  ask  an  old  chronic 
who  has  been  complaining  for  years  to  keep  a  daily  record.  What 
can  be  more  dismal  than  to  enumerate  symptoms,  perhaps  a  large 
number  of  disagreeable  symptoms !  And  yet  how  is  he,  or  how  is 
the  physician,  to  learn  unless  an  account  is  kept?  One  should  of 
course  distinguish  between  ill  health  and  disease.  It  would  not  be 
advisable  to  ask  any  one  with  an  acute  disease  to  keep  a  record, 
nor  if  there  is  some  fatal  disease  that  is  likely  to  kill  in  a  short 
time.  If  any  record  is  to  be  made  in  such  cases  it  should  be  done 
by  relatives,  just  as  is  done  by  hospitals  for  the  information  of 


DYSPEPSIA. 


181 


the  physician;  records  of  the  case  can  be  studied  by  others  and 
conclusions  drawn. 

At  times  one  may  meet  a  patient  who  objects  to  keeping  a  rec- 
ord, saying  he,  or  more  commonly  she,  has  so  many  symptoms  that 
they  can  not  be  kept  account  of.  But  after  all  the  number  of 
symptoms  is  limited.  It  is  commonly  said  that  the  stars  of  the 
heavens  are  uncountable  and  yet  there  are  people  who  keep  track 
of  them  and  if  a  new  one  appears  they  duly  record  it.  In  every 
department  of  human  knowledge  there  are  people  who  keep  track 
of  things;  if  anything  new  appears  they  report  it.  (I  myself  have 
been  keeping  track  of  new  weeds  and  new  diseases  that  appear  in 
the  community.)  When  these  matters  are  properly  explained  to 
patients  they  are  usually  willing  to  keep  a  record — if  not  one  may 
consider  them  "not  worth  while"  and  have  nothing  further  to  do 
with  them. 

Case  Report.  The  following  is  abstracted  from  a  lengthy  re- 
port written  for  physicians.  Perhaps  needless  to  say  in  a  volume 
of  this  kind  one  can  not  enter  into  technical  details. 

A  middle-aged  woman  who  said  she  had  had  ill  health  about 
all  her  life  and  who  had  made  the  rounds  of  the  doctors,  and  natur- 
ally was  discouraged,  finally  came  to  me.  She  agreed  to  keep  a 
record  and  that  was  the  chief  reason  I  accepted  her  as  a  patient. 
Some  time  later  after  we  were  well  acquainted  she  wrote  me  her 
autobiography.  My  own  notes  of  observations  and  discussions 
with  her  in  connection  with  her  own  furnish  enough  data  for  a 
good  sized  volume.  The  woman  was  a  good  listener  and  a  good 
questioner,  the  kind  of  people  with  whom  one  is  apt  to  discuss  all 
sorts  of  topics  relating  to  chronic  ill  health. 

When  I  asked  her  to  give  me  a  list  of  her  symptoms,  she  said. 
"You  better  ask  me  what  symptoms  I  do  not  have  because  I  have 
so  many.  I  have  every  symptom  I  ever  heard  of."  People  who 
have  had  lifelong  ill  health  are  apt  to  acquire  a  lot  of  information 
regarding  symptoms.  She  said  she  had  so  many  she  could  not 
keep  count  of  them.  I  got  out  a  list  of  symptoms  and  told  her 
that  symptoms  like  everything  else  can  be  checked  off  or  cata- 


182  DUSTY    AIR   AND   ILL   HEALTH. 

logued,  and  then  without  asking  leading  questions  I  had  her  enu- 
merate, in  the  end  asking  about  the  presence  or  absence  of  some 
she  did  not  mention.  Her  list  was  a  typical  one;  I  shall  refer  to 
it  presently. 

She  was  being  treated  for  malaria.  She  complained  that  her 
head  buzzed  almost  to  bursting  on  account  of  the  quinine  she  had 
been  compelled  to  take  and  yet  she  was  getting  worse  all  the  time. 
She  had  tried  various  methods  of  getting  relief,  but  she  had  too 
much  sense  to  try  patent  medicines,  Christian  Science,  or  suicide, 
the  latter  on  account  of  her  religion.  Although  at  times  she  was 
passing  large  quantities  of  intestinal  mucus,  no  one  had  questioned 
her  about  it.  She  herself  had  said  nothing  to  physicians  because 
she  assumed  that  it  was  mucus  from  the  stomach  and  that  it  was 
better  to  pass  it  from  the  bowels  than  to  vomit  it. 

She  complained  of  the  superficial  attention  she  got  from  phy- 
sicians and  on  the  other  hand  of  the  large  amount  of  medicines 
she  received,  saying  she  had  taken  a  ''barrel  of  medicine  and  a 
peck  of  pills  and  tablets. ' '  She  gave  a  long  list  of  purgative  med- 
icines. She  had  dieted  severely,  at  times  for  weeks  living  on 
crackers  or  toast  and  weak  tea.  One  summer  she  went  to  the 
Rocky  Mountains  and  while  there  felt  well,  did  not  even  require 
laxatives.  Her  ancestry  goes  back  to  rural  Ireland,  and  that  means 
there  had  not  been  an  active  weeding  out. 

After  getting  her  history  there  was,  the  next  day,  a  systematic 
examination  concerning  the  secretions  and  excretions  by  labora- 
tory methods,  especially  to  determine  the  presence  or  absence  of 
well-defined  lesions  or  disease.  A  day  or  two  later  I  explained 
that  I  found  no  evidence  of  well-defined  disease,  but  that  she  was 
a  dust  victim,  explaining  what  that  meant.  Of  course  I  advised 
her  fully  what  to  do  and  what  not  to  do.  As  a  rule  people  who 
have  been  using  much  medicine  expect  at  least  a  little  from  a  reg- 
ular physician ;  if  they  did  not  expect  any  they  would  go  to  a  man 
who  claims  to  cure  without  the  use  of  medicine.  Now  drugs  or 
medicines  may  be  wholly  unable  to  cure  but  they  may  help.  In 
this  case  there  were  indications  for  some  slight  medication  and 


DYSPEPSIA.  183 

she  was  accordingly  supplied  with  one  or  two  simple  remedies  and 
a  prescription.  I  may  here  add  that  in  a  short  time  she  was  able 
to  discontinue  all  medication  except  an  occasional  laxative. 

Now  a  physician  may  spend  a  good  deal  of  time  in  working 
out  a  case  and  more  time  in  making  explanations,  going  into  de- 
tails and  using  illustrations,  so  that  the  patient  will  understand 
that  health  and  ill  health  are  largely  in  his  own  hands.  They  can 
also  be  told  that  if  they  will  report  faithfully  it  really  makes  no 
difference  to  the  physician  how  they  act,  whether  they  fully  fol- 
low his  advice  or  not,  for  he  will  get  notes,  good  ones  if  advice  is 
followed,  notes  of  the  opposite  kind  if  advice  is  not  followed,  but 
in  any  event  there  will  be  notes.  One  must  explain  that  ill  health 
can  be  worked  out  like  almost  any  other  problem  in  biology  and 
that  if  the  physician  and  patient  fully  co-operate  in  the  business 
of  regaining  health  much  may  be  accomplished. 

So  far  I  have  said  little  about  the  symptoms  that  accompany 
dust  infection  for  the  reason  that  I  assumed  that  the  reader  knows 
more  or  less  about  symptoms  of  ill  health.  I  have  also  assumed 
that  practically  the  only  people  who  will  be  interested  in  this  vol- 
ume are  those  who  have  ill  health  and  that  those  who  have  robust 
health  will  scarcely  be  interested  at  all. 

A  book  in  a  foreign  language  appeals  only  to  those  who  know 
the  language.  Many  books  appeal  to  a  limited  class  of  readers  or 
students,  books  on  science  generally.  A  book  like  Lent's  "Being 
Done  Good"  can  only  be  fully  understood  or  appreciated  by  a 
"rheumatic"  who  has  made  the  rounds  of  doctors,  of  schools  of 
medicine  and  modes  of  treatment;  there  are  allusions  that  even 
a  physician  may  fail  to  understand. 

But  although  a  man  in  robust  health  may  not  fully  understand 
a  book  on  ill  health,  he  can  learn  many  things  about  those  in  ill 
health  and  he  may  learn  that  the  complaints  of  a  friend  or  relative 
may  not  be  at  all  imaginary. 

I  shall  now  briefly  take  up  some  of  the  commoner  symptoms  of 
which  dust  victims  complain.    Later  on  I  shall  consider  symptoms 


184  DUSTY    AIR    AND    ILL   HEALTH. 

from  another  standpoint,  as  being  warnings  to  be  heeded,  perhaps 
as  being  blessings  in  disguise. 

In  general  it  may  be  said  that  the  severity  of  a  disease  varies 
inversely  to  the  number  of  symptoms.  Some  of  the  most  serious 
diseases  manifest  their  presence  by  but  very  few  symptoms.  On 
the  other  hand  people  in  ill  health  may  complain  of  so  many  that 
the  physician  gets  tired  listening  to  the  recital — he  knows  from 
experience  that  people  who  complain  of  many  and  vague  symp- 
toms are  not  seriously  sick. 

Pains  and  aches  throughout  the  body  may  mean  little,  a  local- 
ized pain  may  mean  much.  Recurrent  headaches  may  signify 
little  but  a.  sudden  headache  in  a  man  who  never  had  headaches 
before  may  put  the  physician  on  his  guard  at  once — he  is  apt  to 
think  of  all  sorts  of  serious  consequences.  People  called  neuras- 
thenic often  have  so  many  symptoms  that  they  can  not  readily 
enumerate  them,  they  require  time  to  think.  The  really  sick  man 
can  promptly  enumerate  and  moreover  the  physician  usually  finds 
signs  of  disease.  In  the  case  of  small  children  he  may  have  to 
rely  wholly  on  signs,  on  objective  symptoms. 

A  physician  often  forgets  that  people  have  a  very  vague  idea 
of  what  symptom  names  mean,  and  that  a.  patient's  statements 
regarding  the  presence  or  absence  of  certain  symptoms  must  be 
accepted  more  or  less  guardedly.  One  must  find  out  what  names 
mean  to  them.  It  may  seem  a  very  simple  matter  to  ask  a  long 
list  of  questions  and  find  out  whether  the  patient  has  such  symp- 
toms or  not,  but  as  a  matter  of  fact  it  may  take  much  time  be- 
cause one  must  discover  what  the  patient  really  means. 

Do  you  have  these  symptoms?  is  a  familiar  question  in  the 
advertisements  of  patent  medicines,  followed  by  a  long  list.  Such 
advertisements  as  a  rule  are  as  common  in  the  newspapers  of  dirty 
towns  as  they  are  rare  in  those  of  clean  ones.  They  refer  to  states 
of  ill  health  than  to  the  presence  of  well-defined  disease. 


DYSPEPSIA.  185 

DISCUSSING  SYMPTOMS  OP  ILL  HEALTH  WITH 
PATIENTS. 

To  what  extent  this  shall  be  done  is  at  times  a  problem.  One 
may  err  greatly  regarding  the  attitude  of  patients,  some  refuse 
outright  to  enter  into  details  regarding  their  symptoms.  One  may 
at  times  lose  an  otherwise  "good  patient"  on  account  of  some 
point  that  came  up  incidentally.  Naturally  a  physician  may  spend 
much  time  in  "useless  discussion"  but  every  now  and  then  he 
meets  individuals  with  whom  discussions  are  really  worth  while, 
they  help  to  clarify  ideas.  The  medical  society  is  ordinarily  as- 
sumed to  be  the  proper  place  for  discussions,  but  only  too  often 
discussions  are  about  specific  diseases  rather  than  ill  health  of  the 
kind  considered  in  this  volume.  A  physician  may  prefer  to  dis- 
cuss with  intelligent  patients  who  have  experienced  the  symptoms 
and  the  kind  of  ill  health  here  discussed.  Such  a  remark  applies 
particularly  to  the  country  doctor  living  in  isolation. 

In  the  present  case  symptoms  were  frequently  discussed,  not 
only  their  causes  but  also  conditions  under  which  they  appear  as 
well  as  their  varied  manifestations.  One  can  learn  much  from 
intelligent  patients.  Here  I  shall  briefly  mention  the  chief  symp- 
toms of  which  the  last  mentioned  patient  complained  on  first  com- 
ing to  me,  some  of  which  recurred  now  and  then  while  with  me. 
including  some  general  remarks  on  symptoms. 

Anemia.  She  had  a  sallow  complexion ;  had  been  told  she  had 
anemia  and  also  "decay  of  the  blood"  as  a  girl.  Her  complexion 
had  also  been  explained:  "It's  the  liver."  The  coloring  matter 
of  the  blood  was  approximately  three-fourths  normal.  Sometime 
after  being  with  me  she  gradually  obtained  a  "healthy  complex- 
ion." 

The  matter  of  complexion  is  an  important  one  to  women.  One 
can  readily  understand  how  if  symptoms  generally  subside  there 
may  still  be  cause  for  worry  and  sleeplessness  on  account  of  a 
muddy  complexion.  Even  chronics  have  periods  when  they  feel 
comparatively  well,  but  the  complexion  remains.    The  remedy  for 


186  DUSTY    AIR    AND    ILL    HEALTH. 

a  muddy  complexion  is  good  air  and  especially  exercise  in  good 
air.  This  woman  had  too  good  sense  to  try  any  of  the  numerous 
advertised  blood  purifiers.  She  reasoned  that  if  physicians  could 
not  give  her  medicines  that  would  bring  a  good  complexion  patent 
medicines  would  not  be  apt  to  do  so. 

Anorexia.  In  a  technical  enumeration  of  symptoms  loss  of 
appetite  would  come  under  this  head,  just  as  loss  of  sleep  is  listed 
under  insomnia.  Loss  of  appetite  is  a  very  common  symptom. 
As  already  mentioned  this  patient  at  times  existed  on  crackers  or 
toast  and  weak  tea.  Under  such  conditions  people  do  not  really 
live,  they  merely  exist.  One  may  see  why  in  the  presence  of  a 
constantly  acting  cause  all  sorts  of  tonics  and  appetizers  may 
fail.  I  did  not  give  her  any  tonic;  the  best  " appetizer"  as  well 
as  the  best  tonic  is  good  air.  By  watching  air  conditions,  in  a 
short  time  she  was  able  to  eat  anything.  In  the  very  beginning 
on  coming  to  me  I  advised  her  to  eat  a  little  of  everything  but  not 
to  overeat  in  general  nor  to  overeat  on  any  one  thing.  That  peo- 
ple who  have  an  impaired  digestive  tract  should  chew  their  food 
thoroughly  must  be  self-evident.  A  strong  young  boy  may  be  able 
to  eat  anything  and  everything,  at  all  hours;  the  sick  or  feeble 
and  the  aged  must  be  careful. 

In  connection  with  loss  of  appetite  one  should  also  consider 
the  early  morning  vomiting  which  is  often  due  to  an  effort  to 
bring  up  accumulated  phlegm.  Mucus  in  people  living  under 
dusty  air  is  colored,  at  times  being  black.  It  is  the  solid  residue 
of  the  air  inhaled.  It  is  spat  out  just  as  the  owl  ejects  pellets 
after  having  extracted  the  nutriment.  A  coated  tongue  is  usually 
considered  in  connection  with  loss  of  appetite  but  often  can  be 
assumed  to  exist,  yet  some  patients  think  themselves  neglected 
unless  asked  to  show  the  tongue. 

Chills  or  Chilling  have  been  a  common  symptom  and  being 
misinterpreted  led  to  the  free  use  of  quinine.  People  exposed  to 
infected  dust  who  house  themselves  up  very  frequently  complain 
of  a  chilly  sensation. 


DYSPEPSIA.  187 

This  patient  formerly  complained  much  of  chills  and  chilling. 
On  several  occasions  since  with  me  she  complained  of  chilling; 
each  time  the  source  was  traced  to  dust  except  once  when  there 
was  no  clear  history  (or  I  failed  to  make  the  proper  inquiry  at 
the  time).  Ordinarily  the  chilling  comes  on  promptly  after  a  re- 
turn from  town.  She  seldom  goes  to  town  but  must  go  at  times. 
At  first  she  did  not  understand  about  moist  weather  and  filth 
being  tracked  indoors  where  it  is  pulverized  and  that  although 
there  may  be  no  dust  on  the  streets,  the  stores  may  be  thickly 
filled  with  it.  The  effects  of  an  ordinary  exposure  in  her  case 
last  from  24  to  36  hours,  after  that  the  chilly  sensations  no  longer 
occur.  Here  is  one  of  my  notes  for  16  Dec.  1908,  at  the  time  when 
the  idea  of  dust  infection  was  not  so  fully  fixed  in  her  mind : 

On  coming  in  she  said,  "You  notice  I  got  a  cold."  She  told 
how  she  has  been  getting  along  so  well  since  with  me,  how  she  had 
remained  away  from  crowds  and  bad  air,  but  she  had  risked  going 
into  a  crowd  on  Monday — "when  there  was  no  dust  on  the  down 
town  streets."  However  she  found  the  air  in  the  stores  full  of 
it;  at  the  X  department  store  the  air  was  very  bad  and  oppres- 
sive and  she  did  not  stay  long.  She  breathed  easier  on  getting 
into  the  outer  air,  but  on  getting  home  there  was  again  the  feel- 
ing of  oppression,  "I  felt  as  though  I  did  not  want  to  be  in  the 
house.  I  opened  doors  and  windows — and  that  is  where  I  got  my 
cold." 

I  called  for  her  diary.  She  had  not  entered  "shopping"  (or 
rather  "wanted  to  shop"  for  she  did  not  stay)  but  she  entered 
"got  a  cold."  I  asked  her  to  make  mention  at  the  proper  place 
of  the  shopping,  showing  cause  and  effect.  "When  she  had  made 
the  entry  she  said,  "And  I  thought  I  was  so  careful." 

I  then  explained  the  air  conditions  of  the  last  two  weeks  or 
so,  how  the  deep  snow  had  prevented  street  cleaning  so  that  there 
was  a  great  accumulation  of  filth  now  tracked  into  the  stores  and 
there  pulverized,  becoming  "powdered  poison,"  to  which  those 
susceptible  reacted.  I  told  her  how  some  of  my  old  experienced 
patients,  realizing  that  although  there  was  no  dust  on  the  streets, 


188  DUSTY    AIR   AND   ILL   HEALTH. 

in  fact  just  the  opposite,  knew  that  the  dust  was  in  the  stores 
and  that  it  was  a  very  virulent,  dust,  and  so  they  did  not  go  into 
them.  I  explained  that  "inexperienced  patients"  like  herself, 
those  not  fully  informed,  would  make  just  such  mistakes  and 
"catch  colds,"  but  I  felt  sure  that  from  now  on  she  would  avoid 
similar  repetitions. 

I  referred  to  the  fact  that  I  had  advised  her  not  know  i ugly"  to 
expose  herself  to  dust  influences,  i.  e.,  simply  to  prove  or  disprove 
my  remarks  on  dust  infection;  that  likely  there  would  be  an  un- 
witting exposure — and  this  is  what  had  now  occurred.  I  expressed 
my  belief  that  as  a  new  patient  she  was  getting  along  very  well, 
that  she  had  to  learn  these  things,  that  there  may  be  an  attack  now 
and  then  in  spite  of  every  precaution.  During  holiday  shopping 
people  will  run  the  risk  and  this  may  resolve  itself  into  the  ques- 
tion of  to  shop  or  not  to  shop. 

One  day  some  time  later  in  midwinter  when  it  was  quite  cold, 
with  ice  and  snow,  she  told  me  of  how  she  enjoyed  getting  out  into 
the  cold  and  snowy  weather,  and  how  good  she  was  feeling,  "the 
best  for  years  and  years."  She  contrasted  this  state  with  that  of 
former  years  when  she  would  house  herself  up  and  would  stay  in 
only  to  feel  worse,  while  now  if  there  were  times  when  she  did 
not  feel  perfectly  well  she  went  out  and  that  helped  at  once.  She 
recognized  the  fact  that  there  was  no  necessary  relationship  be- 
tween "cold"  and  "colds"  but  that  such  a  relationship  could 
readily  be  established. 

Formerly  she  dreaded  a  "chill"  and  especially  a  so-called 
"congestive  chill"  (a  term  frequently  used  here  and  a  good  one 
to  "scare"  patients).  "Chills"  are  now  rare,  the  last  one  she 
had  did  not  alarm  her  at  all ;  she  told  me  of  it  over  the  telephone 
in  the  most  matter  of  fact  way. 

Colds.  In  my  own  enumeration  of  the  complaints  of  people 
in  ill  health,  a  "cold"  is  regarded  as  a  symptom,  a  symptom  of 
some  unusual  activity  of  the  body,  really  an  indication  that  the 
body  is  trying  to  get  rid  of  some  foreign  matter.  This  patient 
had  had  frequent  colds,  she  has  had  several  since  with  me.    After 


DYSPEPSIA.  189 

all  that  has  been  said  regarding  colds  there  is  no  need  to  enter  into 
details  here  nor  speak  of  mucus  formation  commonly  called  ca- 
tarrh. 

Constipation.  This  again  is  to  be  regarded  as  a  symptom 
rather  than  an  affection  or  disease.  It  should  be  kept  in  mind  that 
in  this  volume  I  am  speaking  of  dust  victims  who  can  not  be  con- 
sidered as  diseased.  I  have  purposely  ruled  out  individuals  who 
have  well  defined  disease.  I  have  already  mentioned  that  this 
patient  tried  all  sorts  of  laxatives  and  cathartics.  Here  it  may 
be  said  that  there  are  two  great  classes  of  remedies  among  ' '  symp- 
tom-prescribers, "  those  that  give  relief  from  pain,  anodynes  and 
sedatives,  and  those  that  move  the  bowels,  laxatives  or  cathartics. 
Chronics  are  often  alternately  dosed  with  one  kind  and  then  with 
the  other.  The  anodyne  makes  them  feel  better  but  tends  to  lock 
up  the  bowels,  and  then  cathartics  are  used  to  ' '  open  the  bowels, ' ' 
then  the  pain  returns  and  the  process  is  repeated.  Whether  a 
patient  receives  such  treatment  at  the  hands  of  the  lazy  physician 
or  buys  patent  medicines  amounts  to  the  same  thing.  I  have  al- 
ready referred  to  the  fact  that  this  patient  had  not  used  patent 
medicine.  But  she  had  had  her  full  share  of  "  symptom  prescrib- 
ing." I  may  add  that  shortly  after  she  became  my  patient  she 
required  less  and  less  laxative  and  in  time  none  whatever,  ex- 
cepting after  an  acute  exposure.  Here  again  I  would  say  the  best 
anti-constipation  remedy  is  good  air  and  especially  exercise  in  good 
air. 

Constriction  or  Oppression  of  the  Chest.  A  peculiar  sen- 
sation frequent  among  dust  victims  is  described  by  this  term.  The 
sensation  may  be  a  mere  sense  of  discomfort  or  actual  pain.  In 
some  where  there  is  marked  pain  there  is  often  a  history  of  an 
injury  to  the  chest,  as  in  the  present  case  where  there  was  a  fall 
on  the  breast  bone.  The  pain  may  be  marked  after  an  acute  ex- 
posure and  especially  after  dusty  housecleaning. 

Cough.  This  is  a  very  common  symptom  as  one  may  naturally 
expect.     The  primary  object  of  cough  is  to  get  rid  of  irritating 


190  DUSTY   AIR    AND   ILL    HEALTH. 

matter,  which  may  be  readily  brought  up  with  the  free  secretion 
of  mucus  but  with  difficulty  in  the  case  of  a  "  dry  cough. ' ' 

"Cystitis/'  or  rather  "irritable  bladder,"  should  perhaps 
also  be  mentioned.  This  is  a  condition  that  frequently  occurs  in 
dust  victims.  They  may  worry  for  fear  they  have  kidney  dis- 
ease. A  little  codeine  or  heroin  that  allays  the  cough  of  an  irri- 
table throat  usually  also  allays  an  irritable  bladder. 

Dead  Finger  Symptom.  This  is  a  symptom  that  goes  by  va- 
rious names;  at  times  the  hand  is  described  as  "being  asleep."  It 
is  often  described  as  a  feeling  of  "pins  and  needles."  Numbness 
may  extend  over  an  entire  limb.  As  is  well  known,  sleeping  with 
the  arms  under  the  head  may  bring  on  this  symptom. 

Dreaming.  The  conditions  under  which  one  dreams  much  or 
little  or  whether  the  dreams  are  agreeable  or  disagreeable  is  an 
interesting  subject.  This  patient  used  to  have  disagreeable  dreams 
and  also  had  many  sleepless  hours  when  she  would  lie  awake  and 
think  of  her  troubles.  Not  knowing  the  significance  of  her  symp- 
toms and  imagining  the  worst,  she  would  fear  all  sorts  of  terrible 
diseases. 

Dryness  op  the  Skin.  This  is  frequent  in  cases  where  there 
is  a  sallow  color.  There  may  be  a  fine  scaling  off  similar  to  that 
found  on  the  head  in  dandruff.  The  best  remedy  is  good  air. 
That  beauty  specialists  find  many  dupes  among  dust  victims  has 
already  been  referred  to. 

Dyspepsia.  This  term  as  used  in  this  volume  stands  for  a 
symptom,  not  for  a  disease.  Individuals  who  have  many  symp- 
toms, in  other  words  who  complain  of  all  sorts  of  disturbances, 
likely  also  complain  of  disturbances  of  the  stomach  and  alimentary 
tract.  The  term  of  course  is  very  indefinite.  There  may  be  more 
or  less  pain  referable  to  the  stomach,  with  gas  formation  and  the 
presence  of  acid  or  disagreeable  tasting  fluid  coming  up  into  the 
mouth.  If  there  is  much  mucus  there  may  be  vomiting  and  retch- 
ing.   This  was  formerly  a  common  symptom  in  this  patient,  but  as 


DYSPEPSIA.  191 

already  mentioned  now  she  can  eat  anything  and  everything,  "even 
radishes,"  something  about  as  difficult  to  digest  as  one  can  find. 

Flatulency.  A  very  common  symptom  in  dust  victims  is  flat- 
ulency, especially  common  in  people  living  under  city  conditions. 
It  almost  seems  that  people  living  under  simple  life  conditions  do 
not  complain  of  this  symptom  at  all.  It  would  be  interesting  to 
look  up  some  of  the  common  symptom  names,  when  they  first  came 
into  use  and  under  what  conditions ;  in  other  words,  to  what  extent 
are  they  due  to  unsanitary  city  conditions?  That  in  turn  would 
bring  up  the  question  of  the  sanitary  condition  of  the  early  cities, 
as  those  of  ancient  Greece;  many  medical  terms  go  back  to  the 
Greeks.  That  this  patient  was  formerly  annoyed  by  this  common 
symptom  need  scarcely  be  mentioned. 

Emaciation.  This  may  be  considered  an  important  symptom 
or  indicator  of  bodily  conditions,  not  necessarily  alarming.  One 
may  naturally  expect  loss  in  weight  in  people  who  eat  very  little. 
For  the  same  reason  there  may  be  very  little  bowel  movement  and 
yet  some  people  take  laxatives  and  cathartics. 

Flushing.  This  is  an  annoying  symptom  and  formerly  she 
complained  much,  as  far  back  as  she  can  remember,  yet  she  never 
traced  any  connection  between  it  and  exposure  to  bad  air.  She 
readily  saw  the  connection  after  attention  had  been  called  to  it. 
To  some  the  flushing  may  indicate  the  presence  of  fever,  yet  the 
thermometer  may  not  show  any  rise  of  temperature  or  only  a 
slight  transient  one. 

Headache.  Headache  is  a  term  that  covers  a  great  variety  of 
painful  conditions  about  the  head.  There  are  all  sorts  of  headache 
and  all  degrees  of  intensity  of  pain  located  in  any  or  every  part 
of  the  head.  At  times  a  previous  injury  seems  to  determine  a 
localization.  Headache  is  a  very  common  symptom  following  an 
acute  exposure  to  bad  air.  It  may  sometimes  be  the  only  symptom. 
At  present  it  is  customary  to  examine  all  those  complaining  of 
headache  for  defects  in  the  eyes  but  very  few  examine  air  condi- 
tions to  which  a  patient  has  been  exposed,  in  my  experience  one 


192  DUSTY    AIR    AND    ILL    HEALTH. 

of  the  commonest  causes  of  headache.    The  only  "pain  killer"  this 
patient  has  had  since  with  me  was  a  few  headache  tablets. 

Insomnia.  Sleeplessness,  as  already  mentioned,  is  a  common 
symptom  in  dust  victims,  especially  of  the  "nervous  kind"  who 
may  lie  awake  at  night  thinking  over  their  symptoms  and  wonder- 
ing what  it  all  means.  Insomnia  usually  spells  worry.  Ordinarily 
we  think  of  insomnia  as  a  curse  but  it  may  be  a  blessing  in  dis- 
guise, telling  us  to  seek  the  cause  and  avoid  it.  To  the  brain 
worker,  especially  to  the  literary  man,  insomnia,  and  rushes  of 
thought  that  are  apt  to  accompany  it,  may  be  of  service  in  his 
work.  He  may  even  find  a  lot  of  material  in  dreams  and  in  "sub- 
conscious cerebration."  Dust  victims  when  they  realize  what  the 
ordinary  symptoms  mean,  that  they  are  warnings  and  should  be 
heeded,  usually  cease  to  lie  awake,  assuming  that  they  are  getting 
better  air  than  they  had. 

Joint  Pains.  Dust  victims  may  complain  of  an  aching  through- 
out the  body  or  there  may  be  a  localization  about  the  joints,  and 
then  we  are  apt  to  hear  of  "rheumatism,"  if  not  of  gout,  or  the 
terms  rheumatic  and  gouty  are  used.  The  term  uric  acid  is  also 
used.  The  idea  that  uric  acid  is  a  factor  in  ordinary  joint  pains 
has  been  generally  abandoned;  it  applies  only  to  the  exceptional 
case.  But  the  patent  medicine  men  are  using  the  "uric  acid 
theory"  to  a  large  extent,  some  explain  all  pains  and  aches  on 
the  assumption  of  uric  acid  in  the  blood.  This  patient  after  all 
other  pains  and  aches  had  disappeared  still  complained  of  a  local- 
ized pain  in  the  neck;  this  was  finally  traced  to  an  injury  due  to 
the  fall  of  an  ice  chest  lid.  An  acute  attack  of  dust  infection  may 
now  manifest  itself  there  before  any  other  symptoms  appear. 

Lack  op  Ambition.  This  is  a  term  often  used  by  dust  vic- 
tims in  describing  their  sensations.  The  term  at  times  is  used  as 
a  synonym  for  the  ' '  Blues. "  It  is  interesting  to  study  what  may 
be  called  the  mental  symptoms  of  dust  victims,  how  the  mind  re- 
acts under  good  and  bad  air.  There  may  be  stimulation  of  the 
mental  faculties  or  the  opposite.     Some  people  lead  such  a  mere 


DYSPEPSIA.  193 

vegetative  existence,  perhaps  driven  by  necessity  in  the  struggle 
for  existence,  that  they  have  no  time  to  observe  what  is  going  on 
in  the  mind.  One  must  distinguish  between  sensory  and  motor 
impulses.  There  may  be  a  great  desire  to  do,  the  mind  is  active, 
and  yet  there  is  a  lack  of  motor  power,  or  the  opposite  may  be 
true.  We  hear  much  regarding  "suggestion"  and  the  question 
to  what  extent  people  can  be  induced  to  act  upon  "suggestion" 
is  a  very  interesting  one.  One  may  suggest,  in  fact,  one  may  out- 
right lie  to  a  patient  in  chronic  ill  health,  telling  him  he  is  feel- 
ing better  and  he  may  imagine  he  is,  but  the  effects  do  not  last 
long.  In  my  own  work  I  do  not  use  ' '  suggestion. ' '  I  reason  with 
patients  and  explain,  in  other  words,  I  teach  them  about  the  causes 
and  nature  of  their  ill  health,  and  if  they  adopt  the  advice  that 
is  the  outcome  of  a  study  of  similar  cases  they  are  apt  to  be  bene- 
fited as  case  reports  in  this  volume  show.  The  present  patient 
has  had  all  sorts  of  moods  or  mental  states  and  she  now  clearly 
realizes  the  influence  of  air  conditions. 

Muscular  Pains.  Perhaps  everybody  has  an  idea  what  this 
expression  means.  It  is  used  in  distinction  to  pains  that  are  lo- 
cated at  the  joints,  not  to  speak  of  internal  pains.  But  at  times 
it  is  difficult  for  a  physician  to  determine  where  the  pain  really 
is.  The  term  is  as  indefinite  as  rheumatic  or  neuralgic,  names 
which  go  back  to  the  childhood  of  Medicine,  to  the  ancient  Greeks. 
Pain  as  ordinarily  used  by  the  physician  may  refer  to  any  pain- 
ful sensation,  from  a  mere  sense  of  discomfort  up  to  a  pain  so 
severe  that  it  may  kill.  Pain  of  course  is  one  of  the  commonest 
symptoms  of  ill  health  and  of  disease.  In  the  great  majority  of 
cases  pain  is  to  be  regarded  as  a  blessing;  it  gives  us  warning 
that  something  is  wrong.  If  we  heed  the  warning  and  discover 
why  there  is  pain  we  may  be  able  to  prevent  it.  To  use  a  "pain 
killer"  is  the  worst  form  of  treatment.  The  pain  of  such  a  dis- 
ease as  cancer  belongs  to  a  wholly  different  category. 

Nervousness.  This  is  a  term  frequently  used  by  physicians 
as  well  as  by  patients.    Sometimes  we  are  referred  to  as  a  nervous 

[13] 


194  DUSTY   AIR   AND   ILL   HEALTH. 

people,  in  opposition  to  the  primitive  inhabitants,  the  Indians, 
who  were  stoical.  I  imagine  that  if  an  Indian  were  placed  in  the 
heart  of  a  busy  city  and  compelled  to  shift  for  himself  he  would 
quickly  lose  his  stoicism  in  attempting  to  avoid  dangers,  being 
run  down  in  the  street,  and  in  exercising  his  wits  to  make  a  liv- 
ing. The  "guttersnipe"  is  quite  different  from  the  "country 
clod"  on  account  of  his  environment.  From  these  remarks  one 
might  infer  that  the  remedy  for  too  much  nervousness  is  more  or 
less  simple  life.  Perhaps  after  all  "simple  life"  spells  good  air. 
People  differ  largely  on  account  of  the  kind  of  air  they  inhale. 
One  hesitates  to  make  such  a  statement  but  here  it  is  merely 
thrown  in  as  a  possible  explanation — my  patient  found  it  ex- 
plained her  so-called  neurasthenia. 

Palpitation.  Consciousness  of  the  heart's  action  may  appear 
in  any  one  on  undue  exertion  or  from  excitement.  In  some  it 
comes  on  very  readily  and  still  there  may  be  no  complaint  of  ill 
health.  It  is  often  annoying  to  nervous  individuals.  When  the 
heart  is  weak  on  account  of  disease  or  merely  from  lack  of  exer- 
cise, palpitation  may  occur  on  the  least  exertion ;  it  is  always  wise 
to  get  the  opinion  of  a  good  physician  concerning  the  probable 
significance. 

The  patient  here  under  discussion  at  times  had  palpitation 
with  more  or  less  oppression  of  the  chest,  especially  after  her 
weekly  housecleaning.     I  quote  from  my  notes: 

"I  used  to  suffer  every  time  I  cleaned  house.  I  cleaned  up 
every  Friday.  It  used  to  make  me  feel  so  bad  and  gave  me  such 
a  peculiar  sensation  in  the  chest  so  that  I  wanted  to  put  my  hand 
on  my  chest,  like  this,  and  there  would  be  a  peculiar  sensation 
about  the  heart ;  it  would  not  be  a  flutter  really  but  it  was  irregu- 
lar, and  I  used  to  think  it  was  the  movement  [of  sweeping],  and 
then  at  times  I  thought  it  might  be  the  dust,  that  this  might  have 
something  to  do  with  it.     I  used  to  spit  up  black." 

She  had  experimented  to  determine  whether  it  was  brisk  move- 
ment that  brought  on  palpitation  but  found  it  was  just  as  bad 
with  very  slow  sweeping;  she  could  not  understand  it.     The  ex- 


DYSPEPSIA.  195 

planation  is  of  course  easy:  She  swept  with  the  house  closed  and 
slow  sweeping  meant  a  longer  exposure  and  more  inhalation  of 
dust,  with  shallow  breathing,  while  brisk  work  meant  a  shorter 
exposure  but  with  deep  breathing,  the  end  results  being  the  same. 
"With  doors  and  windows  open  and  the  wind  blowing  through 
rapid  or  slow  work  made  no  difference. 

The  simplest  form  of  spitting  black  is  that  which  comes  on 
almost  immediately  after  an  acute  exposure,  as  in  handling  dusty 
coal  at  the  furnace.  There  may  be  a  free  mucus  formation  which 
entangles  the  coal  particles  and  black  spit  may  be  marked.  On 
the  other  hand  is  the  black  spit  that  appears  after  several  days' 
exposure,  as  where  there  has  been  a  continued  exposure  to  smoky 
and  dusty  air,  when  a  good  air  resident,  for  instance,  has  spent 
several  days  in  a  smoky  city.  There  may  be  no  spitting  while  in 
the  city;  whatever  is  inhaled  remains  in  the  lungs.  During  this 
time  the  individual  may  feel  bad  and  finally  the  black  spit  comes 
up.  Again,  the  exposure  may  last  only  a  few  hours,  as  going  to 
a  theater  with  much  infected  dust;  the  process  of  black  spitting 
may  be  inhibited  for  several  days.  In  the  meantime  the  individual 
complains. 

As  a  rule  the  black  spit  most  readily  comes  up  early  in  the 
morning,  in  some  while  still  in  a  recumbent  position,  while  there 
is  little  gravity  to  overcome;  in  others  as  soon  as  they  get  up, 
aided  by  movement.  Every  one  must  determine  for  himself  under 
what  conditions  he  spits  black. 

Perhaps  the  above  list  embraces  the  chief  symptoms  of  which 
people  ordinarily  complain.  Among  other  symptoms  may  be  men- 
tioned tinnitus,  a  buzzing  in  the  ears,  often  marked  in  dust  vic- 
tims; also  sensations  of  dizziness  or  vertigo,  this  latter  however 
is  more  apt  to  occur  in  elderly  people.  Vomiting  and  worry  as 
symptoms  have  already  been  referred  to. 

This  patient  typifies  what  I  frequently  see :  a  large  and  varied 
list  of  symptoms,  apparently  "too  numerous  to  mention,"  and 
yet  in  a  short  time,  depending  chiefly  on  seasonal  and  environ- 
mental influences,  symptoms  will  disappear,  and  then  the  patient 


196  DUSTY  AIR   AND  ILL   HEALTH. 

has  nothing  to  complain  about.  The  patient  may  question  the 
need  for  further  health  supervision.  In  order  to  get  continued 
notes  a  physician  may  offer  medical  supervision  for  a  nominal  fee. 
Unless  there  is  some  agreement  there  may  be  no  further  report- 
ing, or  the  patient  may  return  acutely  ill,  and  then  the  physician 
may  spend  a  lot  of  time  in  determining  present  conditions  and 
what  happened  previously. 


After  the  brief  account  of  the  preliminary  investigation  and 
discussion  of  symptoms,  there  should  now  follow  a  chronological 
account  covering  a  period  of  several  years.  At  first  the  patient 
reported  weekly ;  gradually  the  time  was  increased  to  once  a  month 
and  more  recently  there  was  an  agreement  that  she  should  con- 
tinue indefinitely  without  reporting  but  to  report  promptly  if 
anything  went  wrong. 

There  were  many  discussions  on  various  phases  of  ill  health, 
at  first  wholly  relating  to  herself  but  in  time  when  she  had  "noth- 
ing to  report"  about  herself  there  was  developed  a  habit  of  dis- 
cussing some  of  her  friends  who  complained  of  ill  health,  which 
in  some  cases  she  interpreted  in  the  light  of  her  own  experiences. 
1  have  a  lot  of  what  may  be  called  secondhand  case  notes.  But 
one  never  knows  to  what  extent  one  can  rely  on  secondhand  state- 
ments relating  to  ill  health  and  disease.  Naturally  the  statements 
of  a  physician  have  a  higher  degree  of  probability  than  those  of 
an  uneducated  layman.  But  between  the  statements  of  an  "edu- 
cated dust  victim"  and  a  physician  who  has  never  given  the  sub- 
ject of  dust  influences  any  attention  one  might  be  inclined  to  rely 
on  the  former. 

In  the  course  of  years  there  were  any  number  of  incidents 
that  occurred  which  showred  that  the  assumption  of  dust  infection 
was  a  good  one.  It  enabled  the  patient  to  reduce  her  ill  health 
to  a  minimum,  or  in  other  words  to  maintain  health.  After  we 
were  well  acquainted  I  asked  her  to  give  me  her  autobiography. 
She  promptly  wrote  it  out  in  the  missionary  spirit,  to  the  best  of 
her  ability.     Quite  naturally  people  can  give  only  an  imperfect 


DYSPEPSIA.  197 

account  of  earlier  years,  many  can  not  give  an  account  of  what 
occurred  during  the  past  year.  Need  it  be  added  that  the  phy- 
sician who  does  not  keep  notes  on  his  patients  is  also  unable  to 
give  a  good  account? 

A  case  of  this  kind  can  not  be  done  justice  in  a  few  pages ;  it 
would  really  require  a  volume.  But  if  one  characterizes  too  closely 
the  individual  would  be  identified  in  a  small  community  where 
everybody  knows  everybody  else,  and  so  the  matter  of  fuller  biog- 
raphies must  be  deferred  to  subsequent  years. 

PUZZLING  CASES. 

Cases  that  are  puzzling,  where  one  does  not  always  know  just 
what  is  best  to  do,  constantly  arise.     I  might  mention  one. 

Case  Report.  Middle-aged  woman  from  an  adjoining  county, 
complained  of  chronic  ill  health  for  years,  ever  since  she  was 
married.  On  investigating  I  found  she  was  a  descendant  of  poor 
white  mountaineer  stock,  wholly  unadapted  to  life  under  air  con- 
ditions found  in  most  of  our  villages,  towns  and  small  cities.  She 
had  always  lived  in  the  country  but  on  getting  married  removed 
to  a  small  town;  her  ill  health  soon  led  her  to  lead  a  life  of  se- 
clusion. Naturally  she  ' '  doctored. ' '  She  had  had  all  sorts  of  ex- 
planations, all  sorts  of  diagnoses,  until  in  the  end  she  believed  in 
none,  that  it  was  all  guess  work.  Moreover  she  had  lost  faith  in 
doctors  and  medicines — but  not  quite  all  for  she  was  induced  to 
consult  me  by  some  patients  living  in  her  neighborhood.  I  quickly 
discovered  that  she  was  a  marked  dust  victim  of  the  kind  just 
considered  and  tried  to  explain  what  that  meant  and  what  she 
should  do  and  what  she  should  not  do  in  order  to  reduce  symp- 
toms to  a  minimum ;  of  course  I  proposed  health  supervision.  She 
had  a  daughter  who  was  following  in  her  footsteps.  She  reasoned 
that  if  she  herself  could  be  helped  likely  there  would  be  help  for 
her  daughter. 

One  day  she  came  in  accompained  by  her  husband.  He  was  a 
stout,  robust  man,  florid  faced,  of  the  so-called  apoplectic  type.    I 


198  DUSTY  AIR   AND   ILL   HEALTH. 

at  once  saw  that  he  was  opposed  to  doctors — he  had  good  reasons. 
He  had  spent  thousands  of  dollars  on  account  of  his  wife's  ill 
health  and  had  repeatedly  moved  in  the  hope  that  a  change  would 
help  her.  Naturally  I  tried  to  interest  him  in  the  matter  of  dust 
influences.  In  my  explanation  of  her  ill  health  and  how  this  had 
been  misunderstood,  I  incidentally  remarked  that  she  belonged  to 
the  "low  pressure''  type  of  individuals  while  he  himself  quite 
likely  belonged  to  the  "high  pressure"  type.  He  regarded  this 
as  a  compliment.  Out  of  curiosity  I  took  his  blood  pressure  and 
found  it  to  be  excessively  high,  in  fact  he  might  be  considered  in 
constant  danger  of  an  apoplexy,  and  yet  he  deemed  himself  "thor- 
oughly healthy,"  twitting  his  wife  about  her  low  pressure. 

Now  here  is  a  case  for  medical  ethics.  What  is  the  duty  of 
the  physician  in  such  a  case?  The  man  was  not  my  patient;  in 
fact  he  was  opposed  to  all  doctors.  If  I  spoke  of  the  dangers  of 
a  high  blood  pressure  it  would  greatly  worry  the  wife,  my  patient. 
Yet  both  should  know  that  there  was  imminent  danger,  so  that  the 
man  might  set  his  house  in  order.  What  was  my  duty?  One  is 
apt  to  get  all  sorts  of  opinions  on  asking  the  question. 

Such  or  similar  cases  are  constantly  occurring.  One  learns  in 
the  course  of  time  what  to  do — but  what  one  does  may  not  con- 
form to  what  Mrs.  Grundy  says.  Such  a  case  gives  opportunity 
for  making  all  sorts  of  comments.  One  could  quickly  fill  a  long 
chapter. 

All  that  "medical  science"  can  do  in  some  instances  is  to  point 
out  the  why  and  the  wherefore.  A  "cure"  may  or  may  not  result 
from  the  advice  of  the  physician  who  works  out  a  case  to  his  own 
satisfaction.  To  what  extent  a  physician  will  humor  disagreeable 
patients  and  still  more  disagreeable  relatives  depends,  as  all  ex- 
perienced chronics  know,  shall  we  say  on  circumstances? 

And  as  to  ethics,  it  is  easy  to  say,  Do  unto  others  as  you  want 
others  to  do  unto  you.  If  a  physician  knows  that  medicine  can 
not  cure  should  he  refuse  to  give  any  to  patients  who  want  it?  On 
the  other  hand  if  people  are  opposed  to  physicians,  shall  he  try  to 
instruct  them?     Shall  we  insist  that  the  physician  does  have  a 


DYSPEPSIA.  199 

mission,  one  other  than  giving  drugs,  that  good  advice  may  be  of 
more  value  than  all  medicine? 

How  do  people  look  upon  the  "prophet  of  evil,"  upon  the  phy- 
sician who  makes  gloomy  prognoses?  The  physician  himself  may 
want  to  know  about  his  own  future,  about  the  probable  outcome, 
but  many  people  do  not  want  to  know,  they  want  to  live  on  in 
ignorance,  not  only  about  themselves  but  also  about  relatives.  In 
this  connection  I  may  say  that  I  have  had  patients,  or  applicants 
for  professional  services,  who  in  the  beginning  said  if  anything 
serious  was  found  not  to  tell  them.  Some  physician  may  not  want 
such  individuals  as  patients  at  all. 

While  examining  the  sputum  of  a  preacher's  wife,  I  asked  him 
regarding  the  duty  of  the  physician,  whether  he  should  always 
tell  the  truth.  "Of  course,  always."  A  few  moments  later  when 
I  announced  the  presence  of  tubercle  bacilli,  that  his  wife  had  con- 
sumption, he  became  greatly  agitated  and  said  it  would  never  do 
to  tell  her  the  truth,  completely  reversing  his  opinion  in  the  course 
of  a  few  minutes. 

I  might  add  that  I  failed  to  impress  the  couple  above  cited 
with  the  importance  of  health  supervision.  The  wife  expected  to 
be  cured  by  the  use  of  medicine  and  the  husband  was  opposed  to 
"doctoring."  She  soon  drifted  out  of  my  hands.  The  man  did 
not  become  my  patient  at  all. 

WEEDING  OUT  ON  ACCOUNT  OF  ILL  HEALTH  AND 

DISEASE. 

The  following  cases  coming  under  the  head  of  Membranous 
Catarrh  of  the  Intestines  may  be  cited  to  show  how  families  and 
individuals  are  weeded  out. 

A  middle-aged  woman  brought  her  nearly  grown  daughter  to 
me,  saying  she  feared  consumption  because  her  father,  the  woman's 
first  husband,  had  died  from  tuberculosis.  The  girl  had  had  much 
ill  health  in  school  and  complained  more  or  less  constantly;  she 
was  pale,  although  well  developed.  Good  air  advice  helped  her 
very  much. 


200  DUSTY    AIR    AND    ILL    HEALTH. 

Then  the  mother  told  of  her  own  ills;  she  had  membranous 
catarrh  of  the  intestines.  Later  on  the  husband  also  applied;  lie 
was  reacting  to  irritating  dust  of  a  shop. 

The  people  finally  understood  that  they  were  not  adapted  to 
life  under  dirty  and  dusty  surroundings,  and  one  day  they  packed 
up  and  removed  to  the  northwest.  Here  under  simple  outdoor 
life  all  three  had  good  health,  but  unfortunately  the  girl  got  lone- 
some and  wanted  to  come  back.  The  family  did  return  and  then 
all  again  complained.  How  the  parents  will  end  is  problematical 
but  the  indications  are  that  the  girl  will  die  ere  long  from  tuber- 
culosis.1 What  more  can  one  do  in  cases  of  this  kind  than  advise? 
Nature  is  constantly  weeding  out  certain  types.  To  what  extent 
is  such  weeding  out  preventable?  Some  people  speak  of  Nature 
as  others  do  of  Providence,  as  though  things  can  not  be  helped. 

One  day  I  received  a  letter  from  a  woman  in  an  adjoining 
county  indicative  of  such  a  degree  of  illiteracy  that  I  was  inclined 
to  ignore  it,  but  since  she  was  referred  to  me  by  an  old  patient 
whom  I  had  benefited,  I  read  it  through  and  decided  to  have  her 
come  in  to  talk  matters  over.  I  was  agreeably  surprised  when  I 
found  the  woman's  speech  and  actions  belied  her  letter.  She  was 
bright  and  as  later  events  proved  was  a  good  observer.  One  may 
compare  her  to  the  illiterate  Indian  who  may  be  a  better  observer 
than  the  educated  bookworm.  She  gave  a  lifelong  history  of  ill 
health.  She  is  a  descendant  of  the  poor  whites  of  the  southern 
mountains  and  wholly  unadapted  to  life  under  unsanitary  sur- 
roundings. Her  father  died  soon  after  coming  to  this  State.  Her 
mother  had  "good  health,"  this  however  was  found  to  be  due  to 
the  fact  that  she  lived  in  isolation  on  a  farm;  one  time  when  she 
went  on  a  visit  to  another  State  she  promptly  suffered  and  nearly 
died  on  returning  home.  Good  health  merely  meant  not  being 
exposed  to  the  causes  of  ill  health  and  disease. 

This  woman,  now  aged  forty,  was  married  twice,  has  one  grown 

1  To  what  extent  the  free  formation  of  mucus  is  antagonistic  to  the  invasion  of  the  tubercle  bacillus 
is  itself  an  interesting  question.  Does  the  free  flow  of  mucus  wash  out  irritants  and  infection?  The 
free  flow  of  tears  cleanses  the  eyes. 

I  have  not  studied  a  sufficient  number  of  consumptives  (they  are  really  outside  of  my  present 
field  of  work)  to  enable  me  to  draw  any  conclusions. 


DYSPEPSIA.  201 

daughter  by  a  former  husband  who  was  healthy.  By  the  second 
husband  there  are  three  children,  the  youngest  not  yet  of  school 
age.  The  husband  is  a  dust  victim  who  readily  reacts  on  visits  to 
town,  bringing  home  colds.  The  children  likewise  are  constantly 
having  school  colds.  She  had  an  idea  that  her  colds  were  due  to 
coming  in  contact  with  cold  air  and  as  a  consequence  she  housed 
herself  closely.  On  account  of  her  complaints  of  chilliness  (very 
common  among  those  who  house  themselves)  her  physicians  (she 
has  had  a  number)  believed  she  had  malaria  or  was  malarial  and 
dosed  her  with  quinine.  She  took  quinine  to  such  an  extent  that 
she  was  enfeebled  and  had  to  stop  and  rest  up — so  she  could  take 
more  quinine.  The  simple  advice  to  be  more  out  of  doors,  to  ven- 
tilate the  home  freely,  for  the  husband  to  stay  away  from  town 
and  not  bring  home  colds,  and  to  watch  the  children  to  reduce 
their  colds  to  a  minimum,  was  sufficient  to  cause  nearly  all  her 
complaints  to  disappear. 

She  kept  a  record,  but  not  to  embarrass  her  I  asked  her  to  read 
it  to  me  on  coming  in,  which  she  did  fluently.  As  a  rule  when 
people  are  asked  to  write  they  are  not  longwinded ;  they  express 
themselves  briefly  and  to  the  point.  One  gets  all  data  concisely, 
and  of  course  in  proper  sequence.  In  the  course  of  time  many 
little  things  came  up  that  showed  how  symptoms  are  dependent 
on  bad  air  and  disappear  under  good  air.  I  shall  mention  one 
instance. 

She  complained  that  a  storm,  especially  at  night,  made  her 
nervous  and  restless  and  sleepless.  The  explanation  was  found  to 
be  this:  The  frame  house  was  raised  above  the  ground  and  the 
wind  blowing  under  it  blew  dust  out  of  floors  and  carpets  and 
filled  the  house,  especially  the  bed  room.  The  dust  naturally  con- 
tained infection  from  the  frequent  attacks  of  colds  and  catarrh  in 
the  family.  The  simple  advice  to  open  doors  and  windows  and 
let  the  dust  blow  out  sufficed  to  cause  these  symptoms  to  disappear. 

It  will  be  interesting  to  follow  up  the  fate  of  this  family,  es- 
pecially the  children :  What  will  become  of  them,  will  they  ' '  out- 
grow" their  susceptibilities  or  will  they  die  off,  especially  from 


202  DUSTY   AIR   AND   ILL   HEALTH. 

tuberculosis?  Country  life  or  city  life  is  an  important  question 
with  such  individuals.  Such  a  case  too  leads  one  to  consider  the 
influence  of  medication  (as  too  much  quinine)  as  a  factor  in  "race 
suicide."  • 

In  the  Introductory  chapter  I  referred  to  a  family  history 
where  three  of  the  children  were  very  susceptible  to  dust  infection, 
while  two  were  practically  immune.  Out  of  the  five,  two  have 
been  my  patients.  First  one  of  the  sons  came  to  me.  Being  in- 
telligent he  promptly  grasped  the  idea  of  dust  infection  and  his 
symptoms  diminished  and  then  practically  vanished,  to  return  on 
exposure. 

Some  time  later  he  brought  his  sister  to  me,  a  girl  of  18.  She 
was  evidently  more  susceptible  than  he;  she  could  not  go  away 
from  the  farm  without  getting  ill,  the  symptomatology  being  that 
of  membranous  catarrh  of  the  intestines,  Avith  marked  disturbance 
of  the  whole  alimentary  tract.  When  the  girl  came  in  I  assumed 
that  her  brother  had  told  her  what  I  had  explained  to  him  about 
the  causes  of  his  ill  health,  but  I  found  he  had  not  said  a  word. 
When  I  mentioned  this  to  him  he  excused  himself,  saying  that  if 
he  had  said  anything  about  dust  as  a  cause  of  ill  health  likely  his 
folks  would  not  have  believed  it  (see  note  below)  ;  the  explanation 
was  so  simple  that  it  seemed  ridiculous,  that  people  could  not  be 
made  to  understand  that  there  are  different  kinds  of  dust.  He 
thought  I  could  explain  "the  dust  theory"  better  than  he. 

The  girl  was  found  so  susceptible  that  I  had  to  ask  her  not  to 
come  to  town  at  all,  but  remain  on  the  farm.  For  a  time  I  tried 
to  treat  her  by  mail  but  this  was  found  unsatisfactory.  I  have 
no  doubt  that  if  she  attempts  to  live  under  city  conditions  she 
will  promptly  perish.  Had  she  lived  under  such  conditions  she 
undoubtedly  would  have  perished  long  ago.  How  to  mention  such 
matters  to  a  patient  is  of  course  a  problem.  To  some  one  may 
speak  outright;  to  others  one  must  be  very  careful.  If  the  indi- 
vidual is  wise  he  will  attempt  to  live  within  limitations  and  not 
do  as  others.    The  sister  is  still  on  the  farm.     The  elder  brother 


DYSPEPSIA.  203 

whom  I  never  met  is  also  a  marked  dust  victim,  living  in  southern 
California  where  he  does  very  well  but  has  ill  health  as  soon  as 
he  comes  back  to  this  climate.  The  other  brother,  the  patient  re- 
ferred to,  has  since  also  gone  to  California  to  stay. 

Note  :  One  of  my  patients  on  reading  this  manuscript  thought 
it  necessary  to  explain  why  she  failed  to  do  this  very  thing  in  the 
case  of  some  of  her  relatives.  She  mentioned  a  specific  instance. 
Her  brother  has  a  five  year  old  son,  an  only  child,  whom  she  be- 
lieves to  be  a  marked  dust  victim  because  he  feels  bad,  at  times 
is  actually  ill,  after  being  taken  away  from  home,  a  home  with 
good  air,  as  on  being  taken  to  a  five  cent  theater  or  on  a  railway 
trip.  The  doctor  is  frequently  called  in;  he  gives  medicine  but 
no  explanations.  My  patient,  the  aunt,  pities  the  little  fellow  and 
has  repeatedly  tried  to  explain  to  the  parents  the  cause  and  nature 
of  the  ill  health  and  acute  attacks,  but  they  can  not  be  made  to 
understand.  When  she  tries  to  explain  that  it  is  useless  to  call 
in  the  doctor  every  time,  that  the  proper  thing  is  to  prevent  at- 
tacks, the  parents,  especially  the  sister-in-law,  think  she  is  hard- 
hearted and  is  not  interested  in  the  boy.  For  this  reason  she  is 
inclined  to  say  less  and  less  and  they  in  turn  think  she  is  not 
sure  of  her  ground.  She  believes  if  the  matter  were  presented  in 
detail  to  her  brother,  as  in  this  book,  he  would  readily  adopt  good 
air  advice.  She  feels  herself  utterly  incapable  of  explaining  dust 
infection  although  she  is  fully  convinced  of  its  truth.  She  fears 
for  the  boy  when  he  starts  to  school.  She  is  a  strong  believer  in 
citing  plenty  of  case  reports. 

One  does  not  like  to  make  addenda  after  completing  a  manu- 
script, but  collecting  data  is  a  continuous  process.  At  times  some 
little  note  like  the  above  is  pertinent. 

Weeding  out  and  Schools.  In  old  countries  where  every- 
thing is  crystallized  so  to  speak  and  life  conditions  are  fixed,  peo- 
ple are  born  under  certain  surroundings  and  "inherit"  their 
trades  and  occupations.     It  is  difficult  for  them  to  become  any- 


204  DUSTY    AIR   AND    ILL    HEALTH. 

thing  different  from  their  ancestors.  In  our  country,  a  new 
country,  life  conditions  are  entirely  different ;  there  is  constant 
change.  People  are  not  fixed  to  their  homes,  there  is  moving 
about  and  perhaps  a  frequent  change  of  occupation.  Parents 
often  have  something  better  in  mind  for  their  children  than  their 
own  trades  and  station  in  life.  The  son  of  a  poor  man  may  be- 
come a  teacher,  a  preacher,  a  lawyer  or  a  doctor,  a  newspaper 
editor,  perhaps  a  statesman.  People  generally  realize  that  a  good 
education  is  necessary  (except  perhaps  for  the  role  of  a  ward 
politician,  he  is  mainly  self-taught).  They  will  make  sacrifices  to 
send  the  children  to  school. 

Unfortunately  many  schools  are  so  unsanitary  that  children 
lose  their  health  and  are  unable  to  get  a  good  education.  Now 
the  child  that  can  not  pass  through  the  common  schools  is  not  apt 
to  get  a  college  education  or  go  to  a  professional  school.  The  boy 
whose  parents  intended  him  to  be  a  doctor  may  fail  to  get  the 
necessary  education.  The  following  "case  reports"  are  cited  to 
bring  out  the  "weeding-out  factor"  as  it  applies  to  the  physician 
himself,  both  to  the  physician  in  embryo  and  to  the  man  in  active 
practice.  The  cases  do  not  necessarily  all  come  under  the  head  of 
membranous  catarrh  of  the  intestines. 

Two  of  my  earliest  patients,  both  dust  victims,  living  near 
each  other  in  a  section  of  the  city  where  air  conditions  are  fairly 
good,  each  had  a  boy.  Although  the  children's  health  was  not  the 
best,  yet  they  seemed  to  thrive.  Then  came  the  time  to  go  to 
school.  One  of  the  children  went  to  an  old  school  building  with 
defective  ventilation;  a  catarrhal  process  was  set  up  that  soon 
reached  the  intestinal  tract  and  the  child  perished.  The  other  boy 
went  to  a  new  school  at  the  edge  of  town;  although  there  were  at- 
tacks of  ill  health  now  and  then  he  managed  to  continue.  Ill 
health  attacks  were  readily  traceable  to  exposure.  When  the  par- 
ents finally  were  convinced  that  ill  health  was  due  to  exposure  to 
bad  air  acute  attacks  were  reduced  to  a  minimum.  The  boy  bids 
fair  to  complete  the  grade  schools;  he  is  bright  and  his  mother 
wants  him  to  become  a  doctor  and  not  a  mechanic  like  his  father. 


dyspepsia.  205 

Now  our  high  school  is  in  the  heart  of  the  city ;  air  conditions  in 
and  about  are  bad  and  that  is  where  many  who  complete  the  grade 
schools  fail — and  that  is  where  the  boy  will  likely  fail,  judging 
by  what  happens  when  he  comes  to  town  now  and  then.  The  par- 
ents of  course  will  likely  take  him  out  of  school  when  they  see 
that  he  can  not  keep  up.  The  boy  who  does  not  have  a  good  gen- 
eral education  can  no  longer  enter  medical  college.  Under  the  old 
system  of  attending  lectures  anybody  with  a  good  memory  could 
pass.  The  man  who  passed  the  "best  examination,"  repeating 
the  lecturers'  words,  perhaps  winning  a  prize,  is  frequently  not 
heard  of  in  after  life. 

A  middle-aged  woman  came  to  me  with  a  long  history  of  ill 
health,  not  only  in  herself  but  also  in  her  husband  and  her  only 
child,  a  boy  who  had  reached  the  high  school.  She  had  hoped  to 
make  a  doctor  out  of  her  boy.  The  parents  were  very  saving  and 
neglected  their  own  ills  in  order  to  educate  their  son.  He  man- 
aged to  complete  the  grades,  but  had  difficulty  on  entering  the 
high  school.  He  had  to  stay  at  home  frequently  on  account  of  ill 
health.  The  mother  had  difficulty  to  understand  that  people  are 
not  born  alike  and  that  children  may  not  become  what  the  parents 
intend.  Since  I  could  not  "cure"  her  (she  had  membranous  ca- 
tarrh of  the  intestines)  she  soon  ceased  to  report. 

She  had  an  idea  that  her  boy  was  overworked  at  school,  not 
knowing  that  it  was  the  defences  of  the  body  that  were  "over- 
worked" in  warding  off  infection.  Sometime  later  I  learned  that 
the  son  was  driving  a  delivery  wagon.  Outsiders  are  apt  to  con- 
sider the  station  of  the  parents  and  the  occupation  of  the  father 
and  say,  "It  is  not  in  the  boy. ' '  Some  may  even  say  the  boy  did 
not  inherit  a  type  of  brain  that  stands  schooling  which  would  en- 
able him  to  become  a  physician.  As  a  matter  of  fact  however  the 
boy  is  bright  and  I  have  no  doubt  if  he  could  be  educated  privately 
and  be  sent  to  a  medical  college  where  attention  is  given  to  air 
conditions  he  likely  would  succeed  in  getting  a  doctor's  degree. 
It  may  be  added  that  some  of  our  medical  schools  today  are  giving 


206  DUSTY   AIR   AND   ILL   HEALTH. 

attention  to  ventilation,  some  are  even  teaching  the  importance  of 
sanitation.  The  people  may  expect  much  from  such  colleges.  It 
is  not.  so  much  a  matter  of  "high  standard  in  medical  education" 
as  it  is  a  matter  of  allowing  students  susceptible  to  bad  air  con- 
ditions to  get  a  "good  medical  education." 

Another  mother  who  had  much  ill  health  (membranous  catarrh 
of  the  intestines)  told  me  of  her  only  son  who  also  complained  and 
who  had  difficulty  in  attending  high  school.  He  wanted  a  good 
education  and  if  it  had  not  been  for  his  determination  he  likely 
would  have  dropped  out  long  ago.  Now  I  do  not  remember  whether 
the  boy  wanted  to  become  a  doctor  or  a  preacher,  the  same  argu- 
ment applies  in  each  case.  The  preacher  like  the  doctor  must 
have  a  good  preliminary  education  before  he  goes  to  the  profes- 
sional school.  This  boy  finally  managed  to  get  through  the  high 
school,  although  he  had  one  severe  sickness  that  nearly  carried 
him  off.  Since  attending  a  small  literary  college  in  a  clean  town 
he  has  had  excellent  health.  The  tug  of  war  will  come  when  he 
goes  to  a  professional  school,  perhaps  located  in  the  heart  of  a 
dirty  city  with  air  conditions  about  as  bad  as  they  can  be.  I  do 
not  know  about  air  conditions  in  theological  schools.  Perhaps  the 
student  who  is  not  weeded  out  subsequently  complains  of  Clergy- 
man's Sore  Throat. 

One  day  a  young  farmer  brought  his  wife  to  me.  1  quickly 
discovered  that  she  was  a  dust  victim  of  the  membranous  catarrh 
of  the  intestine  type.  I  gave  the  couple  a  simple  explanation  of 
the  probable  cause  of  ill  health,  proposing  a  systematic  investiga- 
tion to  verify  the  idea  of  dust  infection  and  rule  out  the  presence 
of  definite  disease.  Like  everybody  else,  the  physician  has  differ- 
ent explanations,  an  a-b-c  explanation  for  simple  people,  one  for 
educated  people,  and  a  technical  one  for  physicians.  I  gave  them 
an  hour  of  my  time.  They  said  they  would  consider  the  matter 
and  let  me  know  their  decision.  When  going  out  the  man  said, 
"I  studied  medicine  myself  with  Dr.  X  [in  an  adjoining  county] 
and  went  to  Chicago  for  a  year,  but  my  health  broke  down  and 
I  had  to  go  back  to  farming."    I  reproached  the  man  for  not  tell- 


DYSPEPSIA.  207 

ing  me  this  in  the  beginning,  so  my  explanation  could  have  been 
given  in  different  terms.  He  excused  himself  by  saying  that  the 
explanation  was  really  for  his  wife. 

His  own  history  showed  that  he  was  a  dust  victim.  This  led 
to  a  discussion  of  the  weeding  out  of  the  embryo  doctor.  I  told 
him  that  he  was  just  the  kind  of  man  who  should  have  a  medical 
education.  On  account  of  his  susceptibility  to  bad  air  conditions 
he  likely  would  better  understand  others  in  ill  health  who  react 
to  bad  air  than  the  robust  physician  who  readily  passes  through 
an  unsanitary  medical  college  but  who  unfortunately  does  not  un- 
derstand common  ills  and  who  is  apt  to  speak  of  people  being 
imaginary  ill.1  The  old  philosopher  Plato  believed  the  physician 
himself  should  not  be  too  well  or  he  could  not  properly  under- 
stand his  patients. 

One  of  my  boyhood  friends  went  to  one  of  the  best  Eastern 
medical  colleges  and  became  a  physician,  locating  in  a  large  city. 
One  day  I  received  a  letter  from  him,  asking  me  about  the  com- 
parative advantages  of  practice  in  large  and  small  cities.  Some 
time  later  I  again  heard  from  him ;  he  was  located  in  a  small  town 
in  one  of  the  new  northwestern  states.  He  gave  no  details.  A  year 
or  so  later  I  saw  an  account  that  he  had  committed  suicide.  I  won- 
dered why.  "When  I  last  saw  him,  before  he  entered  medical  col- 
lege, he  was  in  robust  health.  Some  time  later  I  got  some  details : 
He  had  much  ill  health  in  the  large  city  where  he  located,  finally 
he  had  to  leave;  he  went  to  a  small  county  seat,  greatly  disap- 
pointed. He  once  more  tried  city  life  and  finally  committed  sui- 
cide. I  am  inclined  to  believe  he  was  a  dust  victim,  but  I  do  not 
know.    "We  largely  judge  cases  by  similar  ones. 

I  have  had  patients,  more  especially  young  men,  who  when 
advised  to  live  a  "simple  life,"  i.e.,  avoid  crowded  city  life,  say 

1  An  observant  physician  who  has  traveled  widely  on  looking  over  this  manuscript  asked,  "Why 
is  it  that  some  medical  colleges  turn  out  so  many  poor  doctors  while  others  turn  out  so  many  good 
ones?"  at  the  same  time  naming  a  number  of  colleges.  We  readily  came  to  the  conclusion  that  dirty 
colleges  weed  out  the  sensitive  students  and  that  those  remaining  do  not  get  proper  training  under 
dirty  surroundings. 

The  first  lesson  the  university  laboratory  worker  receives  is  that  of  order  and  cleanliness,  his 
success  depend  on  these. 

How  can  cleanliness  be  taught  in  a  high  school  or  a  medical  college  where  everything  is  grimy? 


208  DUSTY   AIR   AND   ILL   HEALTH. 

Ihey  would  as  soou  be  dead  as  live  in  the  country  or  small  town. 
In  at  least  one  case  I  told  a  young  woman  that  to  remain  in  the 
heart  of  the  city  was  equivalent  to  committing  suicide.  Not  hav- 
ing any  data  regarding  her  movements,  I  am  unable  to  say  whether 
my  prediction  was  verified.  The  couple  was  childless  and  there 
at  least  was  "race  suicide." 

At  the  end  of  this  series  I  shall  briefly  refer  to  the  history  of 
a  physician.  He  was  a  country  boy  but  managed  to  get  sufficient 
education  to  go  to  medical  college  and  get  his  degree.  The  col- 
lege was  in  one  of  the  smaller  cities  where  classes  are  not  large 
and  that  means  among  other  things  that  air  conditions  are  not  as 
bad  as  in  some  of  the  large  crowded  cities.  After  several  years 
of  country  practice,  he  decided  to  specialize.  He  took  a  post- 
graduate course  and  then  located  in  a  county-seat,  a  regular  spit- 
ter's  town.  Naturally  his  office  was  in  the  very  heart  of  the  city. 
His  home  was  also  in  the  heart  of  the  city.  That  meant  he  was 
inhaling  infected  air  twenty-four  hours  each  day.  Soon  he  began 
to  complain.  Like  other  physicians,  he  asked  advice  of  his  col- 
leagues and  got  all  sorts  of  opinions,  finally  he  came  to  me.  After 
getting  his  history,  I  came  to  the  conclusion  he  was  reacting  to 
his  environment,  that  he  was  a  dust  victim,  and  that  he  was  not 
fitted  to  practice  medicine  in  the  heart  of  an  unsanitary  city.  That 
was  all  new  to  him.  "I  was  never  taught  anything  like  that  in 
medical  college."  I  advised  him  to  observe  himself  and  if  my 
diagnosis  was  verified  either  to  go  to  the  suburbs  or  back  to  the 
country.  He  continued  some  time  longer  and  then  one  day  he 
packed  up  and  went  to  a  little  country  town.  He  soon  again  had 
good  health.  The  assumption  that  he  was  a  dust  victim  was  cor- 
rect. 

There  is  a  current  belief  that  the  best  physicians  are  drawn 
to  large  cities.  Cases  like  the  above  show  that  there  is  another 
side  to  the  story.  Many  good  men  are  living  in  the  country  be- 
cause they  can  not  bear  city  life.  Or  again  it  is  the  doctor's  wife 
or  a  child  that  compels  him  to  stay  away  from  large  cities.     The 


DYSPEPSIA.  209 

physician  may  or  may  not  know  what  is  the  real  factor,  but  he 
may  know  that  country  life  agrees  while  city  life  does  not.  Beim/ 
a  city  doctor  may  mean  that  a  man  can  stand  life  under  city  con- 
ditions, that  he  can  inhale  a  lot  of  bad  air  with  impunity — and 
this  may  be  the  very  reason  why  many  city  doctors  fail  to  under- 
stand the  people  who  do  react.  Because  of  this  there  is  quackery 
of  all  kinds  and  city  people  have  less  faith  in  the  doctor  than 
country  people.  Physicians  themselves  who  do  not  understand 
that  they  are  dust  victims  may  have  lost  confidence  in  "medical 
science"  as  in  the  case  mentioned  under  dyspepsia.  Will  such  a 
man  go  to  the  large  city  where  he  has  an  opportunity  of  seeing 
and  treating  many  cases,  or  will  he  be  content  to  remain  in  a 
small  community  on  account  of  his  own  ill  health  ? 

This  is  a  railroad  town  and  analogous  cases  are  common  among 
railroaders.  Out  of  the  many  who  enter  the  service  comparatively 
few  are  fully  adapted  to  live  in  smoking  cars. 

Some  of  the  most  annoying  cases  to  treat  are  railroad  people. 
When  the  wife  is  susceptible  to  dust  infection  and  the  husband  is 
immune,  he  constantly  makes  fun  of  the  doctor  who  says  dust  is 
injurious.  He  simply  can  not  understand  the  ill  health  of  his  wife 
and  when  a  man  has  been  paying  thousands  of  dollars  "uselessly" 
he  may  object  to  his  wife  taking  treatment  from  a  "crank  doctor." 

At  the  other  extreme  is  the  man  who  finds  himself  unadapted 
when  he  is  advanced.  He  may  have  a  wife  who  is  immune  and  she 
is  the  one  who  is  unable  to  understand  why  her  husband  can  not 
be  a  passenger  conductor.  From  the  society  standpoint,  a  man's 
business  may  be  important  to  the  wife  and  children  and  they  may 
insist  that  he  attempt  to  get  "used  to  it,"  but  only  too  often  the 
man  fails  completely. 

Who  Makes  the  Best  Family  Physician?  Dr.  —  is  an  old 
family  practitioner  in  a  distant  city.  He  has  the  reputation  of 
being  a  reliable  man;  he  has  had  much  experience  among  sick 
people,  reaching  back  to  the  days  when  prevalent  ill  health  was 
largely  due  to  malaria.  He  has  one  son,  a  boy  who  is  still  in  the 
high  school.    This  son  means  to  be  a  doctor;  he  intends  to  go  to 

114] 


210  DUSTY    AIR   AND   ILL   HEALTH. 

X  Medical  School,  by  many  supposed  to  head  the  list  of  our  med- 
ical schools.  People  say  he  will  make  a  good  doctor,  "it  is  in  the 
family."     Let  us  examine  into  the  matter. 

What  do  we  mean  by  a  good  doctor?  Hippocrates  twenty-five 
hundred  years  ago  characterized  him  fairly  well;  among  other 
things  he  says  of  the  art  of  medicine : 

"Whoever  treats  of  this  art  should  treat  of  the  things  which  are 
familiar  to  the  common  people.  For  of  nothing  else  will  such  an  one  have 
to  inquire  or  treat,  hut  of  the  diseases  and  the  causes  of  their  origin  and 
departure,  their  increase  and  decline,  illiterate  persons  can  not  easily 
find  out  themselves,  hut  still  it  is  easy  for  them  to  understand  these  things 
when  discovered  and  expounded  by  others.  For  it  is  nothing  more  than 
that  every  one  is  put  in  mind  of  what  has  occurred  to  himself."     .... 

The  young  man  is  ambitious,  proud  of  the  fact  that  his  father 
is  a  doctor  and  he  hopes  to  get  the  best  medical  education  to  be 
had.  Why  should  he  not  make  a  good  doctor?  Here  are  some 
arguments  that  go  against  the  popular  conception. 

Old  Dr.  —  had  six  children,  only  this  one,  the  youngest,  reached 
high  school  age;  the  others  died  early  from  the  "diseases  of  civil- 
ization." This  one  son  has  "robust  health."  He  will  likely  be 
able  to  complete  the  high  school  course  and,  being  the  survival  of 
the  fittest,  he  will  likely  be  able  to  complete  a  medical  college 
course.     The  weak  in  his  family  have  been  killed  off. 

Now  the  medical  college  where  he  intends  to  go  is  one  that 
gives  special  attention  to  diseases — common  ill  health  is  apparently 
not  worth  studying.  If  he  goes  to  that  college  he  will  be  well 
grounded  in  many  diseases.  Then  what  will  he  become,  a  special- 
ist or  a  teacher  or  a  good  doctor,  one  that  treats  the  ills  of  the 
common  people?  The  chances  are  he  will  not  be  satisfied  in  a 
small  town  but  will  go  to  a  large  city,  and,  with  the  prestige  of 
his  college,  concern  himself  only  with  the  well-to-do.  Having  "ro- 
bust health"  will  he  be  able  to  understand  common  ill  health  that 
can  not  be  dignified  by  the  name  of  disease?  If  he  does  go  to  a 
small  community  he  will  lead  a  monotonous  life,  there  will  be 
little  to  stimulate  him — but  in  spite  of  all  that  he  may  turn  out 
to  be  a  good  doctor.     Time  will  tell. 


DTSPEP8TA.  211 

Now  and  then  the  physican  meets  young  women  who  want  to 
become  trained  nurses,  they  go  to  a  training  school  and  get  a  good 
training,  and  then  perhaps  go  back  to  their  home  town.  Perhaps 
the  first  case  will  be  in  a  family  that  lacks  all  the  modern  house- 
hold conveniences — the  poor  do  not,  can  not,  employ  a  trained 
nurse  at  all.  Is  it  any  wonder  that  some  quickly  become  discour- 
aged and  are  ready  to  try  something  else? 

A  short  time  ago  I  read  of  a  school  that  trains  servant  girls. 
They  receive  all  sorts  of  instruction,  including  the  use  of  the 
vacuum  cleaner  and  the  automatic  regulation  of  the  furnace  and 
cooking  by  electricity.  Is  it  any  wonder  that  such  a  graduate  is 
greatly  discouraged  on  getting  into  active  work  where  things  are 
radically  different  from  what  she  expected? 

What  the  servant  girl  needs,  and  what  the  trained  nurse  needs, 
and  what  the  doctor  needs  is  not  a  knowledge  of  the  refinements 
but  a  good  knowledge  regarding  the  common  everyday  things 
found  in  every  day  homes,  they  should  not  be  above  the  "little 
things"  of  daily  life. 

Is  it  not  true  that  those  who  get  the  ' '  best  education ' '  and  the 
"best  training"  are  often  dissatisfied  with  the  common  humdrum 
tasks  of  daily  life,  always  dissatisfied? 


VI. 

NERVOUS  PROSTRATION. 


Nervous  Prostration  is  the  third  of  our  Triad  of  National  Dis- 
eases. But  it  is  not  an  entity,  it  is  not  a  definite  disease  that  has 
characteristic  earmarks  by  which  it  may  be  identified,  no  more 
than  dyspepsia.  All  sorts  of  cases  are  grouped  under  the  term. 
At  the  one  extreme  are  what  must  undoubtedly  be  regarded  as 
cases  of  nervous  prostration,  at  the  other  extreme  cases  that  are 
anything  but  that.  Neurasthenia  is  a  synonym ;  it  is  a  good  mouth- 
tilling  word.  Another  synonym  is  overwork,  this  is  especially  used 
in  the  case  of  school  children  and  of  men  who  use  their  brains 
rather  than  their  hands.  We  also  hear  of  nervous  exhaustion, 
nervous  debility  and  psychasthenia.  The  term  hysteria  is  also 
usually  a  synonym,  but  is  rarely  used  because  people  object  to  it; 
the  doctor  who  makes  such  a  diagnosis  is  apt  to  lose  his  patient. 

The  Blues  is  also  used.  People  with  catarrh  and  dyspepsia 
often  have  the  Blues,  thinking  their  condition  hopeless  and  often 
imagining  the  presence  of  diseases  that  will  soon  carry  them  off. 
The  catarrh  victim  is  apt  to  imagine  he  has  or  is  going  to  have 
consumption,  while  the  dyspepsia  victim  thinks  more  or  less  of 
cancer  of  the  stomach.  In  chronic  dyspepsia  there  are  a  large 
number  of  symptoms,  many  of  them  nervous  if  not  mental,  and 
one  may  speak  of  many  dyspeptics  as  being  also  cases  of  neuras- 
thenia. Cases  shade  off  and  symptoms  are  curiously  linked  to- 
gether and  quite  naturally  people  receive  all  sorts  of  diagnoses 
at  the  hands  of  physicians. 

Diseases  are  classifiable  according  to  their  causes  or  according 
to  their  symptom-complexes  or  syndromes.  Tuberculosis,  typhoid 
fever  and  malaria  are  diseases  that  can  be  classified  according  to 
the  active  cause  and  the  cause  can  be  readily  found  by  any  qual- 
ified physician.  In  such  cases  there  can  be  no  doubt  of  the  diag- 
nosis.   There  will  be  no  disagreement  of  opinion  as  to  what  is  the 

(212) 


NERVOUS    PROSTRATION.  213 

matter.  On  the  other  hand  diseases  based  on  symptomatology  or 
group  of  symptoms  always  leave  room  for  doubt.  The  cases  cited 
in  this  volume  are  of  the  kind  where  diagnoses  are  based  on  symp- 
toms and  where  the  opinions  of  physicians  have  often  greatly 
differed.  The  one  common  factor  is  that  the  symptoms  are  trace- 
able to  bad  air. 

People  often  regard  symptoms  as  disease.  Many  look  upon 
cough  as  a  disease  curable  by  medicine.  Asthma  and  dropsy  not 
many  years  ago  were  looked  upon  as  diseases;  by  the  people  they 
are  still  so  regarded.  Some  diseases  have  a  very  definite  cause, 
as  tuberculosis,  typhoid  fever,  malaria.  In  other  diseases  it  may 
be  difficult  to  find  any  cause  at  all,  but  in  the  course  of  time  it 
may  be  found  that  diseases  that  seem  to  have  no  definite  cause  do 
have  one.  Men  are  constantly  at  work  trying  to  find  causes.  Just 
now  there  is  an  active  search  for  the  cause  of  poliomyelitis. 

Catarrh  as  already  mentioned  may  be  due  to  many  and  varied 
causes.  The  respiratory  mucous  membranes  of  some  individuals 
are  very  readily  irritated.  Dyspepsia  also  has  many  causes,  or  in 
other  words,  all  sorts  of  causes  bring  on  disturbances  of  the  ali- 
mentary tract  to  which  the  name  of  dyspepsia  is  given.  Nervous 
prostration  also  has  a  multitude  of  causes.  Men  have  singled  out 
certain  causes  and  written  books  showing  how  people  react,  but, 
strangely  enough,  one  very  common  cause  of  American  Nervous- 
ness or  Neurasthenia  is  usually  overlooked. 

Among  Benjamin  Franklin's  writings  are  many  notes  regard- 
ing colds.  He  evidently  intended  to  write  a  treatise  on  the  sub- 
ject but  did  not  live  long  enough  to  do  it.  The  amount  of  data 
he  brought  together  is  really  remarkable.  He  evidently  had  a 
better  insight  into  colds  than  the  physicians  of  his  time.  It  is  the 
man  who  is  himself  subject  to  colds  who  gives  special  attention. 
Benjamin  Franklin  might  be  considered  our  first  pure  air  advo- 
cate. 

The  term  neurasthenia  was  first  used,  or  at  least  brought  into 
general  use,  by  an  American  physician,  George  M.  Beard,  who 
died  prematurely.     Reading  between  the  lines,  one  sees  how  he 


214  DUSTY    AIR    AND    ILL    HEALTH. 

wrote  all  around  the  eause,  or  the  reason,  why  this  affection  is  so 
common  in  the  United  States.  Had  he  lived  longer  he  likely  would 
have  traced  the  relationship  of  cause  and  effect.1 

The  subject  of  neurasthenia  or  nervous  prostration  is  a  vast 
one;  I  can  not  go  into  details  here.  I  shall  content  myself  with 
citing  briefly  a  few  case  reports  which  may  bring  out  some  points. 
Neurasthenia  or  nervous  prostration  is  so  common  that  everybody 
has  an  idea  what  it  is,  just  as  everybody  knows  about  colds  and 
catarrh  and  dyspepsia.  There  is  no  need  to  give  any  description 
nor  to  detail  symptoms  that  go  with  it. 

In  taking  up  this  group  I  must  again  confess  my  ignorance  as 
in  the  case  of  dyspepsia.  I  did  not  understand  early  cases,  par- 
ticularly those  that  were  not  subject  to  colds  and  catarrh,  but 
when  I  found  that  good  air  advice  benefited  nervous  symptoms 
as  well  as  coughs  and  colds,  I  began  to  suspect  that  dust  influences 
might  have  something  to  do  with  symptoms  of  nervous  prostra- 
tion so-called. 

Neurastheniacs  (or  neurasthenics)  are  people  par  excellence 
who  are  embittered  against  doctors.  As  a  rule  they  have  tried 
everybody  and  everything,  being  still  uncured  they  often  are  very 
bitter.  Because  of  their  antagonism  many  physicians  give  them 
scant  attention ;  some  want  nothing  to  do  with  them  at  all ;  others 
charge  prohibitive  fees;  still  others  give  bitter  nasty  medicine  that 
drives  them  away.  In  the  case  of  the  rich  the  physician  may 
swallow  his  pride  and  humor  the  patient. 


Among  my  earliest  applicants  for  professional  services  on  com- 
ing here  was  a  woman  approaching  middle  age,  clerk  in  a  down 
town  store.  She  had  a  sharp  tongue  and  did  not  have  a  good 
word  for  any  of  the  local  physicians.  I  knew  that  if  I  did  not 
cure  her  I  would  also  come  in  for  a  tongue-lashing.  Although 
people  regarded  me  as  a  "specialist  in  nervous  diseases"  (from 
the  fact  that  I  had  been  connected  with  Insane  hospitals  for  sev- 


1  This  is  a  subject  that  I  discussed  before  the  Section  on  Nervous  and  Mental  Diseases  of  the 
American  Medical  Association,  1905. 


NERVOUS    PROSTRATION.  215 

eral  years),  I  had  so  little  confidence  that  I  could  benefit  her,  not 
to  speak  of  curing,  that  I  did  not  accept  her  as  a  patient  at  all. 
One  may  at  times  give  some  good  advice  or  attention  and  a  pre- 
scription and  then  tell  the  applicant  not  to  return;  in  that  way 
the  individual  may  leave  without  "hard  feelings."  One  may  es- 
cape a  tongue-lashing  although  one  runs  the  risk  of  being  re- 
garded as  "no  better  than  the  rest,"  for  a  prescription  for  medi- 
cine likely  would  not  benefit  much.  How  can  medicine  cure  a 
reaction  due  to  an  unsanitary  environment? 

I  recall  another  somewhat  similar  case  coming  a  year  or  so 
later  where  I  named  a  prohibitive  fee  to  get  rid  of  the  woman. 
She  said  she  would  consider  the  matter  but  never  returned.  Sub- 
sequently she  referred  several  well-to-do  people  through  whom  I 
learned  that  she  considered  me  "a  good  doctor  but  too  expensive 
for  poor  people."  Need  it  be  added  that  the  poor  woman  who 
must  clerk  in  a  store,  constantly  exposed  to  infection,  can  not  live 
up  to  pure  air  advice,  while  a  well-to-do  housewife  living  in  a  clean 
suburban  home  may  readily  follow  such  advice  and  be  benefited? 
The  physician  meets  all  sorts  of  people;  from  agreeable  to  dis- 
agreeable, from  those  fully  able  and  willing  to  follow  advice  to 
those  of  the  opposite  kind;  which  will  he  choose? 

But  there  is  another  side  to  this  story.  Many  of  the  old 
chronics  are  neglected.  They  are  not  studied  and  because  of  this 
there  can  be  no  good  advice.  Many  of  these  old  chronics  are  dust 
victims,  something  I  did  not  at  first  know.  Moreover  I  had  little 
patience  with  a  certain  class  of  people,  those  that  are  commonly 
called  imaginary  ill  or  hysteric  or  "nothing  the  matter." 

Why  do  people  come  to  the  doctor  at  all?  Is  not  something 
the  matter  ?  If  a  physician  can  not  find  a  lesion,  something  wrong, 
is  he  justified  in  speaking  of  imaginary  ills?  If  the  patient  says 
he  has  a  headache  or  has  a  pain  in  the  chest,  the  physician  must 
take  his  word  for  it;  he  may  be  wholly  unable  to  ascertain  the 
truth.  Similarly  with  people  who  have  all  sorts  of  symptoms 
which  are  beyond  the  ken  of  the  physician.  The  complaints  of 
some  neurastheniacs  are  legion  and  yet  there  may  be  nothing  defi- 


216  DUSTY    AIR   AND   ILL    HEALTH. 

nite  od  which  one  can  put  his  finger  and,  like  the  surgeon,  say, 
Here  is  the  difficulty.  When  a  physician  does  take  an  interest  in 
some  of  these  neglected  people  and  gets  their  confidence  and  gets 
them  interested  in  observing  themselves  and  their  surroundings, 
such  patients  become  a  mine  of  information.  They  may  lose  their 
irritability  and  become  the  doctor's  best  friends.  Many  lie  awake 
at  night  worrying  about  their  symptoms ;  they  imagine  all  sorts  of 
things.  When  they  once  properly  understand  they  cease  to  worry, 
and  that  of  itself  has  a  good  influence  on  sleeplessness. 

Many  people  lie  awake  a  large  part  of  the  night.  Why?  The 
conditions  under  which  a  neurastheniac  is  sleepless  is  itself  an  in- 
teresting problem.  Not  to  go  into  details  here  it  may  be  said  that 
as  a  rule  neurastheniacs  are  able  to  sleep  under  good  air  conditions. 

Among  my  early  male  patients  was  a  farmer  approaching  mid- 
dle age.  I  regarded  him  as  a  neurastheniac — the  term  then  served 
as  a  sort  of  catch-all,  all  obscure  nervous  or  mental  cases  were  re- 
ferred to  it.  His  own  relatives  regarded  him  as  "imaginary  ill" 
and  as  being  a  worthless,  good-for-nothing  fellow.  That  the  man 
was  a  dust  victim  wholly  unadapted  to  town  life  (which  he  had 
tried  repeatedly  but  always  went  back  to  the  farm)  I  did  not  real- 
ize until  long  after  he  left  me. 

A  physician  is  often  at  a  loss  to  know  how  far  to  go  in  report- 
ing cases.  People  leading  uneventful  lives  may  not  furnish  "case 
reports"  or  biographies  worth  giving.  On  the  other  hand  people 
with  eventful  lives  are  usually  those  standing  out  in  a  community, 
and  if  one  characterizes  them  too  closely  they  are  readily  identi- 
fied. Then  too  one  hesitates  to  write  about  people  who  in  the 
course  of  years  have  become  good  friends.  Often  before  there  was 
a  mutually  satisfactory  relationship  of  physician  and  patient  there 
may  have  been  a  number  of  disagreeable  incidents.  Neurasthe- 
niacs often  have  sharp  tongues.  Such  remarks  of  course  also  apply 
to  ' '  disagreeable  dyspeptics. ' ' 

(It  may  be  worth  mentioning  that  this  manuscript  has  been 
passed  around  among  several  professional  friends  and  that  some 
quickly  recognized  some  of  the  cases  mentioned,  indeed  some  had 


NERVOUS    PROSTRATION.  217 

been  called  in  consultation,  but  I  feel  confident  that  none  of  these 
physicians  will  reveal  names.  Furthermore  none  asked  regarding 
the  names  of  individuals  who  were  wholly  strange  to  them,  that 
is,  where  they  did  not  suspect  having  met  the  individuals.  In  a 
general  way  it  may  be  said  physicians  are  interested  in  "cases," 
not  in  individuals.  They  care  nothing  for  names.  In  case  reports 
in  medical  journals  names  are  never  given.) 

Clerks  in  stores  are  scarcely  considered  brain  workers  and  yet 
when  they  give  out,  when  health  fails,  some  physicians  speak  of 
nervous  prostration.  According  to  my  observations,  it  would  be 
more  proper  to  speak  of  overwork,  and  "overwork"  here  can  be 
used  in  a  dual  sense :  First,  on  account  of  long  hours,  when  clerks 
begin  early  and  work  until  late  at  night.  All  recognize  that  long 
hours  may  produce  ill  health,  but  in  this  community  stores  are 
closed  at  six  in  the  evening,  one  can  scarcely  speak  of  overwork 
on  this  account.  Second,  one  can  speak  of  overwork  of  the  de- 
fences of  the  body  in  trying  to  get  rid  of  infection.  This  is  par- 
ticularly true  of  crowded  stores  where  little  or  no  attention  is  paid 
to  ventilation. 

The  clerk  who  is  subject  to  colds  and  catarrh  is  not  apt  to  re- 
tain his  position  long.  If  there  is  much  loss  of  time  on  account  of 
dyspepsia  he  may  likewise  not  remain  long.  The  clerk  who  is  able 
to  withstand  unsanitary  conditions  may  in  time  be  promoted  to 
a  responsible  position,  and  then  there  may  be  more  or  less  ' '  worry 
and  tire  of  the  brain,"  and  then  a  physician  can  more  or  less 
truthfully  speak  of  nervous  exhaustion  or  nervous  prostration,  or 
neurasthenia.  And  yet  in  many  cases  there  is  a  better  explana- 
tion, dust  infection.  I  shall  briefly  mention  the  history  of  a  young 
woman  clerk  who  wasi  with  me  for  over  five  years,  long  enough  to 
make  a  fairly  full  study  of  her  case.  Her  history  must  be  con- 
sidered as  "The  short  and  simple  annals  of  the  poor." 

This  young  woman  had  much  ill  health  while  in  school.  She 
had  to  begin  work  early.  On  account  of  her  health  her  widowed 
mother  thought  it  would  be  best  to  have  an  indoor  occupation,  so 
she  would  not  be  exposed  to  the  cold  and  rain  and  snow.     She 


218  DUSTY    AIR    AND    ILL    HEALTH. 

found  a  position  in  a  large  store,  one  that  I  know  not  only  has 
poor  ventilation  hut  is  not  kept  clean,  and  that  meant  to  inhale 
dusty  air  all  day  long.  In  school  she  had  frequent,  colds  and  now 
she  had  not  only  colds  hut  also  catarrh,  but  not  sufficient  to  com- 
pel her  to  give  up  work.  She  soon  came  to  the  conclusion  that 
everybody  had  catarrh,  because  all  the  people  about  her  had  it. 
In  time  the  alimentary  tract  became  deranged;  she  complained  of 
dyspepsia.  After  several  years  she  was  promoted  and  that  meant 
greater  responsibility  and  now  symptoms  of  so-called  nervous  pros- 
tration appeared,  including  worry  and  sleeplessness  at  night. 
About  this  time  she  came  to  me,  after  having  consulted  a  number 
of  physicians.  She  had  had  various  diagnoses,  depending  on  how 
she  was  complaining  at  the  time  or  what  symptoms  were  empha- 
sized. On  investigating  I  promptly  came  to  the  conclusion  she 
was  a  dust  victim  and  was  reacting  to  an  unsanitary  environment, 
that  instead  of  having  had  "all  sorts  of  diseases"  or  at  times  sev- 
eral at  once,  she  had  a  "protean  disease,"  namely  Coniosis  or 
Dust  Infection.  I  pointed  out  that  the  only  cure  was  a  change 
of  occupation,  to  live  under  better  air  conditions.  As  she  had  to 
assist  in  supporting  younger  children,  she  did  not  see  how  she 
could  change. 

There  were  a  number  of  factors  contributing  to  her  ill  health. 
Being  more  or  less  sleepless  during  the  night,  she  would  fall  asleep 
toward  morning  and  lie  in  bed  as  long  as  possible,  eat  a  hurried 
breakfast  and  take  a  car  down  toAvn,  carrying  a  lunch  with  her. 
The  only  water  at  the  store  was  muddy  hydrant  water  which  she 
did  not  use.  As  a  consequence  of  a  lack  of  fluid,  there  was  con- 
stipation. In  the  evening  she  would  be  so  tired  that  instead  of 
walking  home  and  getting  the  outdoor  air,  she  took  a  crowded  car. 
Moreover  on  account  of  her  chronic  ill  health  she  was  stunted, 
sallow,  and  had  an  old  look.  And  yet  she  expected  to  be  cured  by 
medicine  alone. 

She  was  what  physicians  call  an  "easy  mark;"  she  could  be 
loaded  down  with  different  kinds  of  medicine  with  a  charge  for 
each.     But  she  was  unwilling  to   follow  advice — except  that  of 


NERVOUS   PROSTRATION.  219 

swallowing  medicine.  What  is  to  be  expected  under  such  circum- 
stances? I  finally  got  her  to  get  up  earlier  in  the  morning  and 
eat  more  slowly  and  walk  down  town;  likewise  to  walk  home  in 
the  evening.  But  on  the  return  of  shorter  days  she  had  to  abandon 
these  walks  because  the  streets  were  poorly  lighted,  at  times  no 
lights  at  all.     The  use  of  more  fluid  also  helped. 

She  had  little!  to  say  about  the  use  of  patent  medicines,  indi- 
rectly denied  their  use,  but  several  years  later,  when  I  also  pre- 
scribed for  her  mother,  I  found  she  had  been  using  all  kinds  and 
that  at  times  she  used  some  containing  alcohol,  occasionally  to  such 
an  extent  that  she  was  under  its  influence.  There  is  an  old  saying 
about  people  drowning  their  sorrows  in  alcohol.  That  is  practi- 
cally what  some  patent  medicine  users  do. 

As  already  mentioned,  the  store  was  poorly  ventilated.  In  fact, 
one  might  say  there  was  no  ventilation,  and  the  constant  stream 
of  shoppers  brought  in  a  large  amount  of  sidewalk  filth.  Condi- 
tions were  about  as  bad  as  they  could  be.  She  suffered  and  com- 
plained greatly,  and  yet  on  the  return  of  the  open  door  season 
with  free  ventilation  she  would  improve  and  then  would  stop 
"doctoring."  On  the  return  of  cold  weather  there  would  be  a 
return  of  symptoms  and  she  would  come  back  to  me.  Finally 
after  five  years  she  came  to  realize  that  her  ill  health  was  due  to 
her  environment,  and  yet  she  did  not  change  positions  or  occupa- 
tion. She  did  not  even  complain  to  her  employer  about  the  bad 
air  conditions,  knowing  that  if  she  did  she  likely  would  be  dis- 
charged. This  naturally  led  to  a  discussion  of  the  value  of  Unions 
and  of  a  combined  effort  and  of  the  need  for  a  community  as  a 
whole  to  clean  up,  that  the  individual  is  powerless.  The  only  sal- 
vation of  the  individual  under  such  conditions  is  to  get  away. 
Often  the  matter  of  ill  health  and  chronic  ill  health  is  a  problem 
for  the  community  rather  than  for  the  individual;  the  physician 
would  have  to  prescribe  for  the  sick  community,  especially  where 
our  Triad  of  National  Diseases  prevails. 

Cases  of  this  kind  are  common  and  when  the  physician  sees 
the  uselessness  of  attempting  to  cure  he  may  in  time  become  dis- 


220  DUSTY    AIR   AND    ILL    HEALTH. 

gusted.  If  he  gives  any  attention  at  all  it  will  be  only  routine 
attention,  and  individuals  who  get  "only  routine  attention"  in 
time  become  bitter  toward  the  medical  profession.  Naturally  on 
account  of  such  prescribing  some  physicians  in  time  degenerate 
into  mere  symptom-prescribers  and  pill-peddlers.  They  give  the 
people  what  they  want,  not  what  they  really  need. 

This  patient  remained  with  me  for  five  years  when  she  finally 
drifted  out  of  my  hands.  I  had  given  her  a  good  deal  of  time, 
wholly  out  of  proportion  to  her  small  fee,  a  fee  that  in  her  own 
estimation  took  her  out  of  the  charity  class,  although  to  me  still 
a  charity  case.  But  I  got  data.  That  was  my  real  reward.  Per- 
haps needless  to  say  the  longer  an  individual  is  kept  under  obser- 
vation the  more  valuable  notes  become.  But  in  the  end  there  is, 
i here  must  be,  a  termination  of  relationship.  Why  she  ceased  to 
report  I  do  not  know.  I  am  inclined  to  believe  it  was  on  account 
of  her  mother's  exposure  of  the  fact  that  she  used  patent  medi- 
cine. 

Although  I  had  long  felt  like  severing  the  relationship  of  phy- 
sician and  patient,  because  I  was  accomplishing  so  little  and  the 
data  I  got  were  few  and  simple  and  mainly  repetitions,  yet  I  con- 
tinued her  in  the  hope  that  she  would  make  a  change  and  that  I 
could  then  see  how  her  health  would  improve,  in  other  words,  that 
instead  of  getting  a  lot  of  notes  on  "bad  air  influences"  I  would 
get  notes  on  ''good  air  influences."  One  year  she  said  she  was 
considering  the  matter  of  marrying,  but  hesitated  on  account  of 
her  health.  I  expressed  my  belief  that  if  she  got  away  from  the 
store  and  lived  under  good  air  conditions  her  health  would  greatly 
improve.     She  did  not  marry  however. 

How  will  such  an  individual  end?  In  general  one  can  divide 
dust  victims  into  two  groups,  those  with  a  low  blood  pressure  and 
with  more  or  less  deficiency  of  gastric  secretions,  and  likely  to 
end  in  tuberculosis.  At  the  other  extreme  are  those  with  a  tend- 
ency to  high  blood  pressure  and  over  nutrition ;  individuals  of  this 
kind  usually  end  with  "heart  or  kidney  disease."  I  shall  refer 
to  this  subject  later. 


NERVOUS    PROSTRATION.  221 

The  patient  at  one  time  said  if  I  believed'  that  spitting,  dirty 
streets  and  the  neglect  of  cleaning  up  generally  had  such  an  evil 
influence  on  health  it  was  my  duty  to  call  attention  to  these  things 
in  the  newspapers.  Now  I  had  been  doing  that  very  thing,  until 
quite  recently.  Shortly  after  I  came  here  I  wrote  a  brief  paper 
advocating  an  anti-spitting  ordinance.  This  paper  was  published 
in  the  Bulletin  of  the  Indiana  State  Board  of  Health  for  August 
1901.  I  got  a  lot  of  reprints  in  pamphlet  form  which  I  distributed, 
at  my  own  expense.  Then  I  advocated  it  in  the  newspapers.  Did 
I  get  any  thanks?  No,  only  abuse.  Subsequently  I  wrote  many 
papers,  signed  and  unsigned,  regarding  the  improvement  of  mu- 
nicipal conditions,  advocating  pure  air,  pure  water,  clean  streets, 
sewers,  abatement  of  the  smoke  nuisance,  noises,  etc.,  but  after  a 
time  one  gets  tired.  Any  one  who  objects,  especially  to  unsanitary 
conditions,  is  regarded  as  a  kicker,  and  yet  what  many  commun- 
ities need  is  vigorous  kickers.  There  is  always  some  antagonism 
created,  especially  among  people  who  own  considerable  property 
and  who  are  opposed  to  municipal  improvements  on  account  of 
expense.  Many  people  are  lot  and  land  poor,  they  object  to  a 
doctor  who  advocates  improvements.  The  doctor  who  says  noth- 
ing and  does  nothing  but  strictly  attend  to  his  own  business  gets 
along  best  in  life.  Some  may  even  question  why  a  physician  should 
write  a  book  of  this  kind,  which  is  largely  a  criticism  of  unsanitary 
municipal  conditions. 

One  of  my  manuscript  critics  when  she  realized  how  much  ill 
health  this  town  has,  how  many  physicians  there  are  and  how- 
many  drug  stores  with  shelves  loaded  with  patent  medicines,  and 
with  newspapers  full  of  patent  medicine  advertisements,  remarked 
that  the  town  must  be  full  of  ignorant  doctors  otherwise  they  would 
cure  the  ills  of  the  people.  I  might1  offset  this  by  the  remark  of 
another  who  said  the  town  must  be  full  of  ignorant  people  or  they 
would  not  tolerate  such  conditions.  One  can  get  all  sorts  of  opin- 
ions. One  of  my  friends  told  me  he  had  passed  through  the  town 
and  stepped  off  the  car  to  stretch  his|  legs  at  the  railway  station 
near  the  heart  of  the  city  where  the  streets  are  paved  and  where 


222  DUSTY    AIR    AND    ILL    HEALTH. 

tin'  railroad  company  keeps  things  neat  and  clean.  (One  street 
terminates  at  the  station  and  has  comparatively  little  traffic.)  He 
thought  the  town  must  he  a  "nice  and  clean  one."  Another  friend 
had  also  passed  through  but  at  another  railroad  station.  He  no- 
ticed the  dingy  little  station,  with  streets  around  it  deep  in  mud. 
His  opinion  was  that  it  is  a  nasty  and  dirty  town.  A  town  may 
have  only  one  or  two  paved  streets  and  if  a  visitor  comes  to  town 
he  is  sure  to  be  taken  over  these  streets.  The  only  way  to  get  a 
proper  idea  of  a  community  is  to  spend  some  time  in  it  and  go 
all  over  it. 

Since  these  notes  were  written,  a  "Doctor  of  Dead  Towns"  has 
been  here.  He  virtually  prescribed  for  a  sick  community.  He 
was  brought  here  by  a  local  organization  that  wants  to  bring  about 
an  improvement.  He  found  much  to  criticise.  His  "tonic"  pro- 
duced some  results.  Although  this  town  for  years  has  had  good 
cement  sidewalks,  it  was  not  until  the  late  summer  of  1910  that 
any  serious  effort  was  made  to  get  properly  paved  streets.  The 
people  have  at  last  awakened  to  their  necessity. 

European  tourists  who  travel  on  through  trains  and  stop  only 
in  large  cities  get  a  very  imperfect  idea  of  our  smaller  cities  and 
towns.  But  they  learn  much  of  the  condition  of  small  villages  as 
they  pass  through  them,  how  unkempt  they  are  in  comparison  to 
European  villages. 

I  referred  to  the  above  patient  as  an  "easy  mark;"  such  peo- 
ple do  not  take  much  time  of  a  man  who  readily  hands  out  a 
bottle  of  medicine  or  a  box  of  pills  or  tablets.  They  are  ready  to 
give  the  man  who  promises  to  cure  a  trial.  Some  men  claim  to  be 
specialists  for  chronic  cases,  they  may  be  perfectly  willing  to  leave 
the  acute  specific  diseases,  with  a  few  exceptions,  to  the  regular 
profession,  to  the  family  physician.  Such  men  catch  the  chronics 
and  are  able  to  extract  fees  to  an  extent  unknown  to  the  conscien- 
tious physician. 

As  I  write  I  have  before  me  a  local  paper  containing  a  quarter 
page  advertisement  of  an  advertising  doctor.  He  tells  of  his  won- 
derful accomplishments  in  curing  sick  people.     He  is  willing  that 


NERVOUS   PROSTRATION.  223 

the  local  physicians  should  treat  cases  of  nearly  all  specific  dis- 
eases, for  he  says: 

"If  you  have  the  Measles,  Typhoid  Fever,  Pneumonia,  Smallpox,  Scar- 
let Fever  or  any  other  acute  disease  of  that  type,  do  not  consult  Dr.  . 

These  are  the  diseases  for  your  family  doctor  to  treat;  he  gives  that 
class  of  diseases  his  full  time  and  attention,  and  naturally  is  better  pre- 
pared to  treat  them. 

But,  on  the  other  hand,  if  you  suffer  from  some  Deep  Seated,  Com- 
plicated Chronic  Disease  of  the  Stomach,  Bowels,  Rectum,  Kidneys,  Blad- 
der or  other  organs  of  the  Genito  Urinary  Tract  —  THEN  consult 
Doctor .  As  the  family  physician  spends  all  of  his  time  in  the  treat- 
ment of  the  Acute  Diseases,  so  does  Doctor  spend  all  of  his  time 

in  the  treatment  of  the  Special  and  Chronic  Diseases  which  come  under 
his  specialty.  That  is  why  that  any  man  or  woman  who  will  only  stop 
and  give  the  matter  a  little  honest  thought  will  at  once  fully  decide  that 
Doctor can  give  them  MUCH  BETTER  and  MORE  EXPERT  treat- 
ment in  the  disease  which  he  treats." 

It  is  interesting  to  question  people  who  have  been  to  such  men. 
As  just  mentioned  they  know  how  to  extract  the  money  from  the 
pocket  book,  but  as  to  curing  chronic  ill  health  dependent  on  un- 
sanitary conditions,  of  the  kind  described  in  this  volume,  which 
covers  nine-tenths,  or  certainly  three-fourths,  of  all  cases,  why 
that  is  out  of  question.  No  reputable  physician  makes  promises 
to  cure  (simply  promising  to  do  his  best)  but  some  people  want 
promises  and  they  go  to  the  man  who  does  promise.  What  such 
people  need  is  education,  to  know  something  about  their  bodies 
and  how  they  react  under  abnormal  surroundings.  Their  ill  health 
is  preventable  by  cleaning  up  generally,  not  by  drugs  nor  by  the 
"wonderful  new  methods"  of  the  " Fly-by-Night "  who  comes  to 
town,  "Here  to  stay."  A  good  physician  does  not  need  to  adver- 
tise in  such  a  manner;  his  "cured"  or  benefited  patients  wTill  ad- 
vertise him.  The  alliance  of  medicine  men  and  newspapers  is  a 
bad  one. 

The  young  woman  under  discussion  was  a  user  of  patent  med- 
icines. Whether  she  used  them  while  with  me  was  difficult  to  de- 
termine. As  a  rule  I  do  not  accept  nor  retain  patients  who  are 
not  truthful,  as  far  as  such  matters  can  be  ascertained.     I  have 


224  DUSTY    AIR    AND    ILL    HEALTH. 

had  patients  who  told  me  that  while  taking  "doctor's  medicine" 
they  also  took  "patent  medicine,"  unknown  to  the  doctor,  some 
of  whom  never  inquire  ahout  such  matters. 

Although  there  is  much  denunciation  of  the  nostrum  evil  few 
physicians  explain  to  their  patients  the  why  and  the  wherefore. 
When  we  critically  examine  into  the  matter  we  find  that  in  a  gen- 
eral way  patent  medicines  fall  into  three  great  groups,  the  in- 
different, the  anodyne  or  sedative,  and  the  cathartic.  Although 
none  can  cure  all  may  give  relief.  We  all  know  that  a  cathartic 
may  help.  A  "harmless"  patent  medicine  may  even  at  times  give 
relief,  as  when  an  individual  has  been  overdrugged,  either  by  phy- 
sicians or  from  the  use  of  powerful  patent  medicines,  by  taking 
one  that  gives  nature  a  chance  to  assert  herself,  especially  if  taken 
on  the  approach  of  the  open  door  season.  As  a  matter  of  fact 
many  of  the  patent  medicines  are  "perfectly  harmless."  But  a 
medicine  that  is  "harmless"  is  also  powerless.  A  potent  remedy 
on  the  other  hand  improperly  used  is  apt  to  harm. 

Alcohol  may  be  used  to  deaden  sensibility  to  pain  and  to  drown 
sorrow;  opium  may  be  used  for  the  same  purpose  and  is  more 
effectual  to  "kill"  pains  and  aches.  These  are  old  drugs  that 
enter  largely  into  the  composition  of  nostrums.  More  recently 
coal  tar  preparations  have  come  into  use ;  they  also  numb  sensi- 
bility and  are  cheaper.  All  are  of  the  habit-forming  kind,  requir- 
ing larger  and  larger  doses,  or  the  dose  must  be  repeated  more  and 
more  frequently.  The  alcohol  user  is  apt  to  end  as  a  drunkard, 
the  user  of  opium  becomes  an  opium  or  morphine  fiend.  "Dope 
fiends"  are  becoming  more  and  more  common  through  the  use  of 
cheap  coal  tar  preparations.  Many  patent  medicines  readily  in- 
duce habits,  people  resort  to  them  constantly  and  in  increasing 
doses ;  in  the  end  they  only  aggravate  their  ills. 

Alcohol,  opium,  acetanilid  and  other  drugs  of  a  similar  nature 
can  palliate  symptoms,  make  the  user  feel  better  for  a  time,  but 
properly  speaking  they  can  not  cure.  The  conscientious  physician 
is  less  and  less  inclined  to  promise  a  cure,  only  to  do  the  best  he 


NERVOUS   PROSTRATION.  225 

can.  The  patent  medicine  men  on  the  other  hand  "guarantee"1 
their  nostrums  and  promise  cures  without  even  seeing  the  indi- 
vidual. 

A  nostrum  that  has  no  influence  whatever  if  taken  on  the  ap- 
proach of  spring  may  be  credited  with  producing  a  "cure"  be- 
cause people,  and  especially  dust  victims,  naturally  get  better  on 
the  return  of  the  open  door  season.  Patent  medicine  adver- 
tisements in  newspapers  flourish  during  the  closed  door  season; 
they  practically  disappear  during  the  summer  when  infection 
on  streets  and  sidewalks  is  sterilized  by  the  hot  sun  and  when 
there  is  free  ventilation.  The  moment  a  community  begins  to 
clean  up  patent  medicine  advertisements  begin  to  diminish  in 
the  newspapers.  Newspapers  that  go  into  clean  and  sanitary 
homesi  contain  few  patent  medicine  advertisements. 

How  much  explanation  is  needed  to  convince  a  man  that  clean- 
ing up,  change  of  occupation,  or  change  of  environment  is  the 
proper  remedy  for  his  ills?  How  much  time  should  a  physician 
devote  to  the  individual  who  seems  unteachable? 

A  middle-aged  man  came  to  me ;  he  had  heard  of  some  people 
whom  I  had  greatly  benefited,  "cured"  he  thought,  but  in  reality 
I  only  benefited  them  because  they  lived  up  to  good  air  advice. 
Women  can  do  that  better  than  men  who  must  go  down  town  to 
work.  He  "felt  sure"  I  could  help  him,  but  when  I  got  his  his- 
tory I  doubted  it. 

He  came  to  live  in  town  years  ago,  direct  from  the  farm.  Evi- 
dently he  was  wholly  unadapted  to  town  life  and  coming  in  con- 
tact with  sickly  people.  At  first  he  complained  mainly  of  a  de- 
ranged alimentary  tract  and  had  all  sorts  of  diagnoses,  then  nerv- 
ous symptoms  became  more  marked  and  the  term  "nervous  dys- 
pepsia" was  perhaps  the  best  one  that  could  be  applied.  More 
recently  he  was  told  he  was  neurasthenic,  with  of  course  all  sorts 

1  The  Pure  Food  and  Drug  Act,  has  actually  been  of  great  advantage  to  many  patent  medicine 
makers,  in  that  they  are  able  to  add  to  the  label,  "Guaranteed  under  the  Pure  Food  and  Drug  Act." 
People  ordinarily  do  not  understand  that  that  merely  means  the  absence  of  certain  ingredients, 
especially  the  ones  just  mentioned,  or  stating  their  amount. 

[15] 


226  DUSTY   AIR   AND   ILL   HEALTH. 

of  synonyms,  including  "nothing  the  matter,"  a  diagnosis  which 
he  hotly  denied. 

For  years  he  had  been  taking  patent  medicine.  "Why  not?  He 
had  obtained  little  help  from  the  doctors  and  so  came  to  the  con- 
clusion that  it  was  all  experiment  and  guesswork  and  he  might 
do  that  himself  and  at  less  expense.  He  took  "all  the  patent  med- 
icines you  ever  heard  of." 

I  gave  him  a  lot  of  time,  both  in  ruling  out  definite  disease  and 
in  advising  him  how  to  reduce  symptoms  to  a  minimum.  He  was  a 
dust  victim,  wholly  out  of  harmony  with  his  surroundings,  but  I 
could  not  induce  him  to  make  a  change.  When  I  saw  that  he 
expected  at  least  some  medicine  I  gave  him  a  little,  such  as  was 
really  indicated  at  times,  as  laxatives  and  headache  tablets.  In 
time  I  found  he  placed  less  faith  in  my  advice  than  in  the  medi- 
cine and  wanted  medicine  to  take  regularly,  and  then  I  began  to 
lose  interest.  Just  then  however  he  became  distributor  of  samples 
of  all  kinds,  including  patent  medicines,  and  that  gave  an  oppor- 
tunity to  try  all  sorts  of  nostrums,  "free,  gratis,  for  nothing." 
I  now  encouraged  him  to  continue  to  report ;  I  got  all  sorts  of  data 
regarding  patent  medicines.  I  no  longer  disputed  with  him  but 
allowed  him  to  believe  we  both  were  experimenting  to  find  the 
"right  medicine."  "When  I  finally  got  tired  he  had  not  yet  found 
the  right  one. 

To  make  the  story  complete  it  should  be  added  that  the  man 
was  so  poor  that  he  could  not  buy  the  kind  of  food  needed,  could 
not  take  necessary  rest  nor  buy  sufficient  fuel  that  would  keep 
the  house  warm  without  stopping  up  all  cracks  and  crevices. 

While  revising  these  notes  a  patent  medicine  circular  was  left 
at  the  door,  entitled  ' '  Short  Stories, ' '  stories  alternating  with  tes- 
timonials.    On  page  9  occurs  on  item  as  follows: 

FUNNY  ADVICE  BY  FUNNY  DOCTORS. 

It  is  absurd  to  direct  "good  nourishing  diet,  rest,  fresh  air,"  etc.,  to  a 
poor  man  or  woman  who  has  hardly  enough  to  keep  body  and  soul  together. 
But  this  is  thoughtlessly  done  every  day.  M.  Brieux,  the  well-known 
author  of  Les  Avaries,   the  play   in   which   the  ravages   of  syphilis   are 


NERVOUS  PROSTRATION.  227 

openly  presented,  discusses  this  subject  in  Le  Matin.    The  following  regime 
was  prescribed  for  a  patient  who  applied  for  treatment : 

1.  Avoid  fatigue,  damp  and  cold.  2.  Clothe  very  warmly ;  wear 
flannel  next  to  skin.  3.  Eat  well ;  underdone  meat,  7  to  15  ounces  a  day, 
to  be  taken  scraped  and  pounded  in  cold  buillon,  or  as  balls  in  powdered 
sugar.  Raw  or  soft  boiled  eggs — four  to  six,  if  possible  eight  to  ten  a  day. 
Sardines  in  oil,  two  daily,  butter,  watercress,  cooked  and  raw.  A  large 
cup  of  cocoa  with  milk  in  the  morning.     Beer  with  the  meals. 

And  to  whom  was  this  regime  given?  To  a  beggar  peddler,  covered 
with  filthy  rags,  who  earned  a  few  sous  a  day. — Selected. 

If  one  were  to  comment  on  that  one  could  say,  Some  doctors 
are  more  than  funny,  they  are  foolish.  They  give  advice  utterly 
impossible  for  poor  people  to  follow.  On  the  other  hand,  is  it 
good  for  poor  people  who  can  not  afford  the  necessaries  of  life  to 
resort  to  patent  medicine  ?  To  what  extent  will  that  benefit  them  ? 
The  remedy  is  for  the  charity  organization  to  seek  out  the  poor 
and  give  them  adequate  assistance.  The  man  who  is  in  danger  of 
starvation  is  not  a  case  for  a  little  medicine,  nor  does  giving  a 
little  food  suffice;  he  requires  a  sufficiency.  It  would  really  be 
better  for  some  people  to  die  outright  than  to  die  a  lingering 
death  of  weeks  and  months  from  starvation,  attended  by  all  sorts 
of  misery.  The  same  is  true  in  regard  to  the  use  of  nostrums. 
If  people  knew  the  hopelessness  of  taking  nostrums  and  medicine 
they  might  make  some  determined  effort  to  get  better.  As  it  is 
the  patent  medicine  man  allows  them  to  live  on  in  hope — and 
finally  die  in  despair. 

When  I  first  began  the  practice  of  medicine  I  did  not  inquire 
what  patients  had  been  taking  or  who  had  been  the  previous  phy- 
sician ;  I  wanted  to  make  my  own  diagnoses  and  prescribe  accord- 
ing to  my  own  ideas.  In  the  course  of  time  I  found  that  most 
applicants  had  ill  health,  it  is  really  the  exceptional  individual 
who  has  a  well-defined  specific  disease,  and  then  I  discovered  that 
it  pays  to  find  out  what  people  have  been  taking  and  who  has 
been  prescribing  for  them,  for  manifestly  if  an  individual  had  had 
symptoms  indicative  of  malaria  and  had  been  dosed  with  quinine 
it  would  be  useless  to  give  more  quinine;  or  if  a  patient  had  been 


228  l>r$TY  AIR   AND  Itt  KEAtTtt. 

told  there  was  sluggishness  of  the  liver  and  had  been  severely 
purged  a  different  mode  of  treatment  might  produce  better  re- 
sults. Then  too  it  pays  to  ask  who  the  previous  physicians  were. 
One  can  judge  people  by  their  physician,  as  one  can  judge  them 
by  their  clothes.  The  patient  who  has  been  drifting  about  among 
cheap  symptora-prescribers  really  never  gets  the  best  that  Medi- 
cine has  to  offer  and  the  diagnoses  of  such  men  may  not  be  worth 
considering  or  repeating. 

It  also  pays  to  ask  whether  an  applicant,  or  new  patient,  has 
been  using  patent  medicine.  It  gives  one  an  idea  of  his  mental 
status.  The  man  or  women  who  has  had  a  high  school  course  in 
anatomy  and  physiology,  in  hygiene  and  sanitation,  is  not  apt  to 
be  a  purchaser  of  patent  medicine  and  does  not  constantly  require 
a-b-c  explanations — why  certain  kinds  of  ill  health  are  prevalent, 
why  ill  health  must  be  considered  a  reaction  largely  due  to  an 
unsanitary  environment  and  incurable  by  drugs  or  by  outlandish 
modes  of  treatment. 

Poor  and  ignorant  people  and  patent  medicine  go  together. 
That  means  especially  poor  people  living  under  unsanitary  sur- 
roundings ;  those  living  in  isolation  are  usually  healthy  and  have 
little  need  for  medicine.  Intelligent  people  likely  have  a  good 
family  physician  who  by  timely  advice  prevents  ill  health  and 
disease.  The  man  who  has  his  nose  on  the  grindstone  and  must 
work  as  long  as  possible  is  to  be  pitied.  He  may  be  willing  enough 
to  follow  advice  but  is  wholly  unable  to  do  so ;  he  wants  a  doctor 
who  is  going  to  cure  him  by  the  use  of  medicine.  He  is  not  apt  to 
have  as  his  physician  a  man  who  gives  detailed  advice.  There  are 
people  moreover  who  place  patent  medicines  and  the  doctor's  med- 
icine on  the  same  plane.  They  seem  to  think  it  is  merely  a  ques- 
tion of  getting  the  "right  medicine"  and  that  if  they  keep  on  try- 
ing they  will  find  it.  But  at  times  even  intelligent  people,  or  what 
must  be  regarded  as  such,  use  patent  medicines,  due  mainly  to  the 
way  nostrums  are  brought  before  the  public,  how  they  are  adver- 
tised, or  recommended  by  those  who  believe  they  have  been  ben- 
efited. 


NERVOUS   PROSTRATION.  229 

Some  people  avoid  patent  medicines  that  are  boldly  advertised 
as  such  but  they  may  be  "taken  in"  by  the  "reading  notice." 
Newspapers  differ  greatly  in  how  they  sell  their  advertising  space. 
Some  are  very  careful  regarding  the  character  of  the  advertise- 
ments they  admit.  Properly  considered,  "newspaper  medicine" 
as  commonly  understood  is  an  anomaly.  Why  should  the  news- 
papers, many  of  them,  be  in  league  with  nostrum  makers  and 
quacks  of  all  kinds  to  defraud  the  public  in  offering  impossible 
cures,  offering  to  cure  what  no  reputable  physician  can  cure  or 
under  conditions  that  make  a  cure  impossible?  Many  physicians 
require  their  patients  to  go  to  bed;  the  nostrum  maker  may  offer 
or  even  "guarantee"  to  cure  while  a  man  is  at  work,  a  potent  rea- 
son to  the  poor  man  who  must  work  as  long  as  possible.  Many 
affections,  or  conditions  of  ill  health,  are  wholly  incurable  in  the 
presence  of  the  cause,  the  reaction  will  only  cease  when  the  cause 
is  absent.  The  Hay-fever  victim  has  learned  that  neither  patent 
medicines  nor  doctors  can  cure.  If  he  wants  relief  he  must 
"change  climate."  A  man  going  to  a  new  home  may  find  it  so 
malarial  that  he  has  difficulty  to  live ;  if  he  is  wise  he  will  get  out. 
Our  own  State  in  former  years  had  a  reputation  that  attracted 
very  few  immigrants ;  they  passed  on  further  west.  A  man  moving 
to  a  new  city  may  or  may  not  know  that  he  is  running  the  risk  of 
contracting  typhoid  fever  on  account  of  bad  water  supplies;  he 
may  decide  to  leave  or  at  least  take  the  precaution  to  sterilize  the 
water.  People  who  are  prudent  are  apt  to  avoid  such  cities  en- 
tirely. If  people  realized  to  what  extent  ill  health  is  dependent 
on  bad  air  conditions  they  would  shun  many  dirty  cities. 

The  number  of  patent  medicine  advertisements  in  a  city's  news- 
papers gives  some  general  idea  regarding  the  presence  or  absence 
of  sanitation.  People  in  health  ordinarily  pay  no  attention  to 
such  advertisements,  just  as  others  fail  to  see  the  market  reports 
or  read  base  ball  news.  Newspapers  are  written  for  all  sorts  of 
people,  everybody  is  likely  to  find  something  to  interest  him.  If 
there  is  too  much  that  is  disagreeable  a  man  will  likely  not  sub- 
scribe at  all.     Some  newspapers  claim  to  be  "The  best  family 


230  DUSTY    AIR    AND    ILL   HEALTH. 

paper."  They  usually  are  the  ones  that  contain  a  minimum  of 
patent  medicine  advertisements;  they  may  refuse  to  insert  adver- 
tisements disguised  as  reading  notices  or  use  headings  that  mis- 
lead. When  a  community  is  oversupplied  with  newspapers  there 
is  apt  to  he  keen  competition.  Some  of  the  papers  are  continually 
on  the  verge  of  bankruptcy,  they  are  apt  to  accept  all  sorts  of 
questionable  advertisements.  We  see  a  somewhat  similar  condi- 
tion of  affairs  in  the  case  of  doctors;  the  community  that  is  over- 
supplied  likely  contains  men  who  make  all  sorts  of  promises  to 
cure  in  order  to  get  patients. 


A  clergyman  who  might  be  regarded  as  a  neurastheniac  came 
to  me.  He  noticed  some  mild  symptoms  that  led  him  to  think  of 
consulting  a  physician,  when,  at  the  psychological  moment,  his 
eye  met  a  "reading  notice,"  a  disguised  advertisement  of  a  patent 
medicine  that  can  be  "mixed  at  home."  At  the  bottom  occurred 
the  statement.  "The  editor  can  endorse  this  prescription."  The 
prescription  itself  contained  several  well-known  ingredients  and 
then  the  "joker,"  the  name  of  the  nostrum.  The  preacher 
promptly  sent  around  to  the  druggist  and  had  this  "prescription" 
filled.  Unfortunately  druggists  will  fill  prescriptions  without  the 
physician's  signature;  formerly  the  druggist  was  the  righthand 
and  co-worker  of  the  physician;  today  he  is  mainly  the  agent  of 
the  patent  medicine  men.  He  will  even  wrap  the  doctor's  medi- 
cine in  a  patent  medicine  circular.  This  preacher  took  the  medi- 
cine for  some  time  but  instead  of  getting  better  he  got  worse  and 
then  he  came  to  me.  When  I  got  his  history  and  saw  what  he  had 
been  taking  (he  showed  me  the  bottle)  I  smiled  and  explained  how 
he  had  been  taken  in.  He  became  very  indignant  that  people  are 
fooled  by  advertisements  gotten  up  like  reading  matter  and  that 
an  editor  should  endorse  a  nostrum.  He  asked,  Is  there  no  way 
to  stop  it? 

With  a  man  of  this  kind  one  is  apt  to  discuss  things  in  detail. 
I  pointed  out  to  him  that  in  proportion  as  people  became  educated 
and  learned  something  about  physiology  and  pathology  and  sani- 


NERVOUS    PROSTRATION.  231 

tation  they  know  better,  that  in  proportion  as  communities  clean 
up  there  is  no  need  for  nostrums  that  can  not  cure  although  they 
may  palliate  or  disguise  symptoms. 

All  my  patient  needed  was  good  air.  In  a  clean  community 
likely  he  would  have  no  symptoms  whatever. 

In  a  dusty  city  one  is  apt  to  find  all  sorts  of  advertisements 
of  cough  cures,  but  is  a  "cough  cure"  really  a  remedy?  Ought 
there  not  really  be  a  cleaning  up  and  a  doing  away  with  the  cause 
of  cough,  especially  of  irritating  dust?  The  same  is  true  for  ca- 
tarrh ;  people  who  have  good  air  have  no  catarrh.  It  is  also  true 
of  a  host  of  symptoms,  many  of  which  are  designated  as  "dis- 
eases" by  the  patent  medicine  men.  Some  patent  medicine  men 
may  give  warnings  not  to  use  strong  medicine,  but  to  use  their 
mild  medicine  regularly,  "every  day."  One  may  question  whether 
that  is  good  advice.  Many  of  the  patent  medicines  are  of  the  habit- 
forming  kind,  the  victim  finds  it  almost  impossible  to  stop  them. 

The  above  mentioned  patient  camel  to  me  after  his  first  experi- 
ence with  patent  medicine.  Some  people  come  to  a  doctor  with- 
out having  taken  any  patent  medicine  at  all,  but  most  of  the  old 
chronics  come  after  having  tried  many  if  not  ' '  all  they  ever  heard 
of."  Now  suppose  I  had  not  spent  a  lot  of  time  in  making  expla- 
nations, that  he  had  no  disease  but  was  only  reacting  to  an  unsan- 
itary environment,  is  it  not  reasonable  to  conclude  that  he  would 
have  made  continued  efforts  to  "get  cured?" 

I  have  had  many  patients  tell  me  that  at  first  they  were  op- 
posed to  taking  patent  medicines,  but  when  they  found  the  doc- 
tors unable  to  cure  or  even  give  marked  relief  they  "experi- 
mented" in  the  hope  that  they  would  find  something  that  would 
help.  They  thought  it  all  guess'  work.  The  old  explanation  that 
"people  love  mystery"  did  not  appeal  to  them — to  them  doctor's 
medicine  or  his  Latin  prescriptions  were  just  as  "mysterious"  as 
the  patent  medicines.  It  pays  to  tell  such  patients  why  they  are 
still  uncured  and  why  they  are  incurable  by  the  use  of  medicines 
of  any  kind  and  from  any  source.  Whether  a  bottle  of  a  doctor's 
"favorite  prescription"  is  handed  out  directly,  or  his  prescription 


232  DUSTY    AIR   AND    ILL    HEALTH. 

filled  by  a  druggist,  or  whether  a  bottle  is  bought  ready-made  is 
to  many  immaterial. 

On  the  other  hand  I  have  had  patients,  exceptional  ones  to  be 
sure,  who  came  for  advice  and  not  for  medicine.  If  the  matter  is 
not  clearly  explained  to  them  (why  they  have  ill  health  dependent 
on  their  environment)  one  feels  sure  that  in  time  they  might  also 
try  patent  medicines.  Why  not?  Advertisements  confront  them 
on  all  sides.  People  who  have  been  "cured,"  who  assert  such  at 
least,  tell  them  of  this  and  of  that  nostrum.  When  people  get 
desperate  they  will  try  anything  tor  get  relief. 

Some  nostrum  makers  publish  testimonials  from  "home  peo- 
ple," or  "from  people  you  know."  Several  years  ago  I  cut  out 
a  number  of  these  published  by  a  certain  firm.  With  one  or  two 
exceptions  the  people  lived  on  back  streets  of  neglected  parts  of 
the  city.  I  myself  did  not  know  a  single  one  of  the  testifiers.  I 
took  these  testimonials  to  the  medical  society  and  asked  the  phy- 
sicians if  they  knew  the  people.  A  few  of  the  individuals  men- 
tioned were  unknown  to  any  of  the  physicians;  some  were  known 
to  all,  they  had  had  experience  with  them.  With  two  or  three 
exceptions  all  were  known  as  deadbeats.  Physicians  considered 
them  people  not  worth  while.  There  are  various  reasons  why  this 
is  so,  as  there  are  various  reasons  why  such  people  will  sign  a 
patent  medicine  testimonial. 

A  man  complaining  all  winter  may  of  course  be  benefited  by 
taking  some  nostrum  at  the  proper  time,  especially  on  the  return 
of  the  open  door  season  (seasonal  influence).  Some  patent  medi- 
cines are  really  based  on  prescriptions  of  physicians;  if  taken  at 
the  right  time  and  under  the  right  conditions  they  will  benefit,  but 
that  does  not  mean  cure.  The  reason  the  doctor's  medicine  even 
of  a  simple  kind  is  usually  efficacious  is  due  to  the  fact  that  it  is 
given  after  more  or  less  study  of  the  patient.  There  are  very  few 
medicines  that  are  really  curative,  we  need  only  think  of  quinine 
and  real  malaria.  There  are  any  number  of  ailments  that  doctors 
can  not  cure  and  that  patent  medicines  can  not  cure.  Nature  does 
the  curing,  medicine  can  only  help,  it  may  turn  the  balance  in  our 


NERVOUS   PROSTRATION.  233 

favor.  Many  states  of  ill  health  are  wholly  dependent  on  environ- 
ment. The  man  who  works  in  a  dusty  factory  may  cough  inces- 
santly. He  may  have  severe  asthma.  Unless  he  changes  his  occu- 
pation no  medicine  will  cure  him.  The  experienced  hay-fever  vic- 
tim is  apt  to  smile  when  promised  a  cure,  even,  hy  a  doctor.  The 
patent  medicine  people  have  practically  abandoned  advertising 
cures  for  hay-fever;  too  few  people  "bite"  to  make  it  worth  while. 

Recently  some  nostrum  makers  have  substituted  the  term  "re- 
lief" for  "cure."  This  change  is  due  to  the  operation  of  the  Pure 
Food  and  Drug  Act.  At  times  one  sees  advertisements  in  which 
occur  one  or  more  testimonials  from  people  who  claim  to  have  been 
cured,  while  the  heading  of  the  advertisement  may  claim  relief 
only.  Likely  in  time  the  testifier  will  discover  that  it  was  only 
temporary  relief,  for  probably  with  the  return  of  the  closed  door 
season  he  will  again  relapse,  particularly  if  he  is  a  dust  victim. 

Drugs  and  medicines  and  cures  of  all  kinds  are  innumerable. 
The  shelves  of  the  average  drug  store  groan  with  them,  and  yet 
the  physician  uses  very  few  medicines,  the  true  and  the  tried. 
With  Socrates,  on  passing  through  the  toy  shop,  he  can  say,  "How 
many  things  are  here  which  I  do  not  need. ' ' 

While  writing  these  notes  two  incidents  occurred  which  may 
be  worth  recording. 

At  a  meeting  of  a  medical  society  a  young  physician  had  a 
"cold;"  he  asked  one  of  the  older  and  more  widely  experienced 
men, 

"Doctor,  when  you  have  a  cold  what  do  you  do  for  it?" 

"I  wear  it  off,"  was  the  gruff  reply. 

While  at  a  drugstore  the  druggist,  whom  I  know  well,  in  a 
hoarse  whisper  asked,  referring  to  his  own  condition,  "What  do 
you  call  it,  aphonia?"    I  call  it  frog  in  the  throat,  I  replied. 

One  of  the  two  men  in  the  store  at  the  time  inquired,  "Do 
you  have  any  cure  for  a  cold?"  The  druggist  immediately  an- 
swered, "Yes,  some  good  ones."  The  men  were  of  a  kind  to  ap- 
preciate a  joke  on  the  druggist  and  so  I  loudly  called  back,  "Do 
you  have  any  real  good  cold  cures?"    Of  course  he  had  to  reply 


234  DUSTY    AIR    AND    ILL   HEALTH. 

in  the  affirmative.  Then  I  shouted  back,  "Why  don't  you  try 
some  of  them  yourself?" 

The  druggist  did  not  enjoy  the  joke.  His  cold  cures  were  to 
sell,  not  to  try  on  himself. 

For  years  I  have  been  taking  five  daily  newspapers,  two  from 
our  capital  city  and  three  local  ones,  not  to  speak  of  Sunday  pa- 
pers. The  reason  for  taking  so  many  is  to  study  the  patent  med- 
icine and  quack  advertisements.  To  what  extent  do  different  pa- 
pers admit  them  to  their  columns  and  where  do  they  draw  the 
line?  Some  apparently  admit  everything,  others  draw  certain 
lines.  One  paper  may  admit  all  sorts  of  patent  medicine  adver- 
tisements but  refuse  the  advertisements  of  the  quack.  One  won- 
ders to  what  extent  a  newspaper  looks  after  the  people's,  the 
reader's,  interest,  and  to  what  extent  it  is  purely  selfish,  acting 
upon  the  principle,  Let  the  buyer  beware.  Many  of  the  monthlies 
and  weeklies  are  careful  of  the  sort  of  advertisements  they  admit 
to  their  pages,  even  newspapers  are  beginning  to  draw  lines.  But 
so  far  newspapers  that  do  not  admit  patent  medicine  advertise- 
ments are  exceptional. 

Now  in  this  volume  I  am  attempting  to  show  that  many  ills, 
complaints  and  symptoms  for  which  patent  medicines  are  used  are 
incurable  by  drugs,  because  they  are  reactions.  The  only  cure  is 
to  get  away  from  the  cause.  But  medicines  may  palliate ;  some 
blunt  sensibility  and  give  relief  from  pain,  but  that  does  not  mean 
cure.  If  the  people  clearly  understood  this  they  would  not  con- 
stantly be  trying  old  patent  medicines  and  all  the  new  ones  that 
appear.    But  who  is  to  teach  them? 

What  occurs  when  the  average  individual  in  ill  health  goes  to 
the  average  doctor  ?  We  all  know  what  takes  place :  often  while 
the  patient  is  telling  his  complaints  the  doctor  is  putting  up  some 
medicine  which  he  hands  out  with  directions  how  to  take,  with 
scarcely  a  word  of  good  advice.  Is  it  not  true  that  the  average 
patient  expects  to  be  cured  by  the  medicine,  just  as  the  user  of 
patent  medicine  expects  to  be  cured?  If  one  fails,  he  tries  an- 
other.   Medicine  is  medicine.    Many  will  ask,  What  is  the  differ- 


NERVOUS    PROSTRATION.  235 

ence  between  medicine  sold  over  the  druggist's  counter  and  that 
handed  out  by  the  doctor?  Some  doctors  are  merely  competitors 
of  the  druggist  in  selling  medicine,  in  peddling  pills. 

Suppose  a  young  doctor  with  high  ideals  comes  to  a  community 
where  the  people  use  doctor's  medicines  and  patent  medicines  in- 
discriminately, where  they  try  one  or  the  other,  perhaps  both  at 
the  same  time.  How  will  he  attempt  to  tell  the  people  that  their 
ills  are  not  curable  by  medicine?  that  he  does  not  propose  to  give 
drugs  for  ills  that  are  incurable!  If  people  understand  that  the 
new  doctor,  a  regular  graduate,  is  not  going  to  give  them  drugs, 
will  they  call  on  him  at  all?  If  he  would  speak  out  he  would  lit- 
erally be  committing  professional  suicide.  He  would  not  get  a 
footing.  He  would  not  make  a  living.  In  order  to  teach  the  peo- 
ple he  must  still  give  them  what  they  want  and  gradually  teach 
them  better.  But  the  young  doctor  soon  marries  and  then  has  a 
family  to  support  and  that  means  he  is  less  and  less  inclined  to 
give  the  people  what  they  need,  merely  giving  what  they  want, 
and  soon  his  practice  does  not  differ  from  that  of  those  about  him. 
He  gives  out  medicine  as  freely  as  the  rest — and  then  is  it  any 
wonder  that  the  people  place  him  and  his  medicine  on  a  level  with 
that  of  the  patent  medicine  men?  The  doctor  who  does  not  do  as 
others  is  exceptional. 

A  newspaper  has  a  duel  function,  it  supplies  its  readers  with 
news  and  supplies  the  needs  or  wants  of  the  buyer  and  seller.  The 
man  who  has  something  to  sell  uses  the  newspapers  as  the  go- 
between.  The  man  who  wants  something  will  make  his  wants 
known  through  advertisements.  The  patent  medicine  man  has 
something  to  sell;  why  should  he  not  advertise  his  wares? 

The  doctor  has  something  to  sell,  call  it  medicine  or  call  it  skill 
or  professional  services,  but  instead  of  using  the  newspaper  he 
hangs  out  a  sign.  The  doctor's  sign  often  means  "Medicine  for 
sale."  (That  applies  in  nine  cases  out  of  ten;  the  tenth  man  may 
be  wholly  exceptional.)  Because  there  are  practitioners  who  do 
not  sell  medicine  or  write  prescriptions  other  doctors  are  "down 
on  them,"  just  as  they  are  down  on  the  newspaper  that  advertises 


236  DUSTY    AIR    AND    ILL    HEALTH. 

patent  medicine  and  that  takes  the  advertiser's  part.  This  state 
of  affairs  will  likely  continue  until  the  people  themselves  make  a 
change. 

Addendum  :  On  p.  209  I  asked,  Who  makes  the  best  family 
physician?  Old  patients  are  constantly  giving  me  their  opinion. 
A  friend  in  a  distant  town  on  reading  this  manuscript  told  me  of 
a  young  man,  the  son  of  a  doctor,  who  went  through  a  very  un- 
sanitary high  school  with  flying  colors.  He  was  undecided  what 
to  do  and  for  a  year  had  an  outdoor  job  and  then  concluded  to  go 
to  medical  college.  He  did  not  lose  a  day  on  account  of  ill  health, 
although  the  medical  college  was  located  in  the  heart  of  a  large 
and  dirty  city.  Shortly  before  graduating  while  home  on  a  short 
vacation  he  told  of  the  kind  of  work  he  was  going  to  do  after  get- 
ting his  medical  degree.  He  was  going  to  treat  "sick  people," 
with  strong  emphasis  on  sick;  he  did  not  want  "old  ladies"  nor 
"old  chronics"  who  are  constantly  complaining,  "who  think  they 
are  sick. ' '  He  thought  that  kind  of  people  needed  faith  and  mind 
cures,  they  did  not  need  a  regular  physician.  "Thus  spoke  inex- 
perienced youth." 

Here  again  my  comment  is:  How  unfortunate  that  medical 
colleges  do  not  teach  about  common  ills  and  the  influence  of  en- 
vironment. How  can  a  young  doctor  in  robust  health,  who  has 
had  no  instruction,  and  no  practical  experience,  understand  the 
kind  of  cases  that  he  meets  on  getting  out  into  the  world  ?  If  such 
a  young  doctor  meets  an  old  chronic  who  takes  an  interest  in  him 
he  may  be  told  a  few  things  about  chronic  ills.  Even  the  old 
"granny"  may  give  him  a  few  ideas  that  she  has  learned  through 
bitter  experience.  Having  learned  more  or  less  about  the  sciences 
on  which  Medicine  rests,  he  of  course  will  learn  much  more  quickly 
than  people  who  have  not  such  a  foundation.  As  already  men- 
tioned, such  a  young  physician  may  have  very  high  ideals  but  in 
time,  unless  he  has  some  guiding  principle  for  treating  ill  health, 
he  degenerates  into  a  mere  routinist  or  symptom-prescriber  like 
those  all  about  him. 


NERVOUS  PROSTRATION.  237 

In  affections  and  states  of  ill  health  due  to  had  air  the  proper 
remedy  is  to  clean  up,  to  get  away  from  dirt.  If  a  community 
will  not  clean  up,  the  individual  had  best  go  to  one  that  does.  The 
florist  knows  what  will  happen  to  his  plants  when  he  fails  to  keep 
them  clean  and  from  being  overcrowded;  a  sudden  blight  will 
carry  them  off.  The  farmer  knows  that  his  domestic  animals  when 
closely  housed  become  sickly  and  die.  Among  human  beings  living 
under  unsanitary  surroundings  there  may  be  much  ill  health,  many 
symptoms,  but  it  is  well  defined  disease  that  kills.  Many  symp- 
toms can  be  palliated.  A  cough  may  be  ' '  cured  by  a  cough  cure ; ' ' 
there  are  all  sorts  of  remedies  to  "kill  a  pain,"  but  the  cause  of 
the  cough  and  of  the  pain  may  be  operative  just  as  before.  The 
absence  of  symptoms  merely  gives  the  individual  a  false  sense  of 
security.  If  he  knew  what  the  cough  or  the  pain  signified  he 
would  not  resort  to  such  treatment.  Many  drugs  blunt  the  nerv- 
ous system;  they  numb  pains  and  aches.  We  know  how  a  man 
who  suffers  bodily  and  mentally  will  drink  to  excess,  drown  his 
pain  and  sorrow  in  alcohol,  and  how  others  will  take  opium,  per- 
haps in  the  form  of  hypodermic  injections.  There  are  a  number 
of  drugs  that  can  be  used  for  this  purpose;  if  one  is  not  used, 
another  will  be.  Alcohol,  opium,  cocaine  and  acetanilid  can  largely 
replace  one  another.  If  those  in  misery  are  denied  the  use  of  one, 
they  are  apt  to  resort  to  another.  I  have  repeatedly  met  people 
who  had  been  benefited,  who  felt  better,  by  the  use  of  certain  nos- 
trums (particularly  of  the  kind  that  blunt  sensibilities)  but  dis- 
continued their  use  for  fear  of  forming  "the  habit."  The  num- 
ber of  patent  medicines  that  are  used  habitually  is  remarkable. 

The  subject  of  the  relationship  of  patent  medicines  to  the  ab- 
sence of  cleanliness  is  a  large  one;  likewise  that  of  the  influence 
of  the  mind  on  ill  health  and  disease,  as  manifested  by  the  various 
faith  and  mind  cures.  "When  we  study  reputed  cures  we  find  that 
many  are  intimately  bound  up  with  a  change  of  seasons  and  change 
of  surroundings. 

Many  persons  unqualifiedly  praise  or  condemn  certain  things. 
Physicians  almost  invariably  condemn  the  patent  medicine  men 


238  DUSTY    ATR   AND   ILL   HEALTH. 

and  modes  of  treatment  which  they  do  not  or  perhaps  can  not 
countenance.     People  often  want  to  know  the  reason  why. 

When  we  begin  to  inquire  why  patent  medicines  and  fads  of 
all  kinds  that  aim  to  cure  ills  are  so  common  in  our  country  we 
may  find  it  due  to  the  way  in  which  people  live  and  are  exposed 
to  ill  health  producing  conditions.  One  of  these  factors  I  have 
attempted  to  point  out  in  this  book.  I  feel  confident  that  if  people 
cleaned  up  generally,  had  clean  towns,  clean  streets  and  clean 
homes  (and  that  means  also  clean  food,  clean  water  and  clean  air, 
clean  clothing),  there  would  be  vastly  less  ill  health  and  disease 
than  there  is  at  present.  Some  one  has  truly  said  that  chronic 
ills  are  mostly  of  our  own  making,  and  that  means  they  are  largely 
preventable. 

Sanitarians  have  observed  that  as  soon  as  a  city  gets  a  pure 
water  supply  salubrity  greatly  improves;  there  is  less  disease  and 
ill  health  that  primarily  is  not  dependent  on  the  use  of  bad  water. 
One  might  say  people  live  up  to  their  good  water  supply;  that 
they  are  less  tolerant  of  dirt  elsewhere.  It  is  difficult  to  teach  the 
value  of  good  clean  air  to  those  who  drink  dirty  water  and  live  on 
dirty  and  dusty  streets;  one  almost  comes  to  the  conclusion  that 
the  first  step  in  getting  clean  air  is  to  get  clean  water. 

I  recall  years  ago  reading  of  a  city  man,  a  clerk,  who  received 
as  a  Christmas  present  from  an  aunt  a  fine  marble  statue.  He 
had  expected  something  more  useful.  When  the  statue  was  put 
on  the  center  table,  the  table  seemed  out  of  harmony;  a  fine  new 
center  table  had  to  be  bought  to  do  it  justice.  Then  it  was  noticed 
that  the  table  was  out  of  harmony  with  the  other  furniture  in  the 
parlor  and  that  meant  to  get  new  furniture.  Then  they  noticed 
that  the  carpet  and  wall  paper  were  out  of  harmony.  The  refur- 
nished parlor  was  in  such  marked  contrast  with  the  other  rooms 
that  in  time  the  house  was  completely  refurnished,  even  to  the 
kitchen.  Then  the  inside  of  the  house  was  in  such  marked  contrast 
to  the  outside  that  more  improvements  were  demanded.  The  im- 
provements extended  to  the  lawn  and  to  the  street  and  alley.  Then 
the  neighbors  noticed  how  their  own  homes  were  out  of  harmony 


NERVOUS   PROSTRATION.  239 

and  they  began  to  improve.  The  marble  statue  became  the  means 
of  renovating  a  whole  neighborhood. 

Clubs  of  all  kinds  flourish  today.  How  many  are  devoted  to 
a  study  of  the  legends  of  early  days?  How  many  devote  them- 
selves to  the  heathen  in  foreign  lands?  How  many  study  their 
own  community,  its  wants  and  needs? 

In  this  country  the  majority  rules.  We  can  have  protection  or 
free  trade,  prohibition  or  license.  Men,  and  women  too,  warmly 
take  sides.  But  what  sort  of  citizen  is  apt  to  take  the  side  of  dirt 
and  dust  and  ill  health  and  misery?  Club  women  can  do  much, 
the  women  generally  can  do  much,  for  in  what  does  keeping  a  city 
clean  differ  from  keeping  a  house  clean? 

One  of  my  old  patients  who  has  had  much  experience  with 
court  house  conditions  in  looking  over  this  manuscript  expressed 
her  dissatisfaction  that  I  did  not  have  more  to  say  about  court 
house  air  and  city  hall  air  and  the  dust  factor  in  politics — how 
men  who  do  not  smoke  and  chew  and  spit  take  little  interest  in 
politics  and  how  the  women  are  disgusted  with  politics  and  de- 
mand a  hand  in  electing  officials.  Now  this  is  a  subject  on  which 
I  have  collected  a  lot  of  data  but  it  would  take  time  to  go  over  all. 
Likely  the  argument  would  run  along  this  line,  I  am  not  neces- 
sarily speaking  of  local  conditions. 

"Slates"  are  usually  discussed  and  made  up  in  places  where 
air  conditions  are  very  bad,  only  too  often  in  saloons.  Individuals 
designated  as  "best  citizens"  usually  do  not  take  part.  At  the 
primaries  air  conditions  are  usually  bad  and  the  "best  citizen" 
too  often  remains  away,  especially  if  he  is  influenced  by  bad  air. 
In  his  absence  ward  politicians  control  matters  and  nominate  can- 
didates, "slates  go  through."  Only  too  often  candidates  are  poli- 
ticians who  can  live  under  bad  air  conditions,  often  bull-necked 
apoplectic  individuals  (who  however  usually  die  prematurely  on 
account  of  some  cardio-vascular  affection)  or,  on  the  other  hand, 
men  who  do  not  react  to  bad  air  but  who  are  as  clay  in  the  hands 
of  the  bosses.  Now  in  the  early  days  political  meetings  proper 
were  held  in  the  open  but  today  "stump  speeches"  are  made  in- 


240  DUSTY   AIR   AtfD   ILL   HEALTH. 

doors  and  usually  under  very  bad  air  conditions,  so  bad  that  "best 
citizens"  stay  away.  If  the  women  attended  likely  there  would 
be  less  tobacco  chewing  and  smoking.  The  typical  politician  as  we 
know  him  is  not  concerned  with  the  welfare  of  the  city  and  to  dis- 
tract attention  from  local  problems  he  injects  State  and  National 
politics  into  city  affairs  and  befogs  local  issues.  When  the  best 
citizen  comes  to  vote  he  finds  very  little  difference  between  the 
candidates  of  the  two  great  political  parties;  he  does  not  care 
whether  he  votes  or  not.  But  there  are  men  who  do  vote,  some 
are  paid  for  doing  so.  "Writing  to  the  newspapers"  after  the 
election  does  no  good. 

Remarks  about  city  politics  and  politicians  also  apply  to  county, 
State  and  Nation.  Is  it  not  true  that  only  too  often  the  man  who 
is  elected  is  of  the  kind  who  always  has  a  cigar  in  the  mouth  and 
puts  his  feet  on  the  table?  What  is  to  be  expected  from  him  in 
the  matter  of  cleanliness?  Is  it  any  wonder  that  the  women  are 
disgusted  and  demand  the  right  to  vote  and  that  many  States  are 
giving  them  this  right  ?  In  other  States  men  are  beginning  to  vote 
for  candidates  other  than  those  of  the  two  great  political  parties ; 
just  now  socialist  candidates  are  receiving  many  votes.  Socialism 
in  its  best  sense  seeks  the  common  good.  If  the  socialists  live  up 
to  their  ideals  their  party  has  a  great  future  before  it,  especially 
in  the  management  of  our  cities. 

Socialism  does  not  mean  anarchy.  The  typical  anarchist  as 
described  in  the  newspapers  resembles  the  hero  of  the  blood  and 
thunder  stories.  Anarchists  usually  meet  in  the  back  room  of 
some  saloon  under  horribly  bad  air  conditions.  They  react  and  the 
reaction  manifests  itself  mentally,  sometimes  reaching  the  point 
of  insanity.  The  best  remedy  for  anarchism  is  cleanliness,  a  fact 
which  socialists  seem  to  recognize. 

(Writing  as  I  have  does  not  necessarily  mean  that  I  am  a  so- 
cialist; as  a  matter  of  fact  I  am  largely  a  believer  in  individual- 
ism. But  when  it  comes  to  the  matter  of  cleaning  up,  in  making 
cities  sanitary,  I  believe  the  individual  is  helpless ;  it  takes  a  com- 
bined effort.     Theoretically  we  believe  that  all  men  are  born  free 


NERVOUS   PROSTRATION.  241 

and  equal,  but  practically  speaking  no  one  believes  it.  It  is  im- 
possible for  all  to  live  on  the  same  plane.  As  an  evolutionist  I 
believe  that  many  individuals  are  out  of  harmony  with  their  en- 
vironment and  with  the  spirit  of  the  times.  As  a  physician  T 
believe  that  the  man  who  does  not  give  attention  to  symptoms  of 
ill  health  is  not  of  a  type  to  survive  under  complex  life  conditions.) 

The  other  day  one  of  my  old  patients  hailed  me  on  the  street, 
"Did  Mr.  X  come  to  you?"  naming  a  court-house  official.  No,  he 
did  not.  "Well,  I  recommended  you  to  him  and  he  said  he  would 
come.  He  has  been  complaining  of  a  sore  throat  and  catarrh  for 
some  time,  and  has  been  doctoring.  I  told  him  not  to  waste  any 
time  but  come  to  you.  You  may  look  for  him  at  any  time. ' '  He 
made  a  few  remarks  on  what  a  nice  sort  of  man  Mr.  X  is,  and 
indicated  that  I  should  do  my  best,  which  I  promised  to  do — but 
I  did  not  thank  him  for  referring  the  man  to  me. 

Now  although  my  old  patient  knows  more  or  less  about  dust 
influences  I  do  not  know  whether  he  suspected  that  official  to  be  a 
dust  victim.  Assuming  that  he  is,  in  what  does  "doing  my  best" 
consist?  Should  I  tell  him  that  he  is  not  adapted  to  the  air  of  the 
court-house,  that  he  is  a  farmer  and  not  a  politician  and  that  he 
ought  to  live  on  the  farm?  Is  he  "sick  enough"  to  follow  good 
air  advice  or  will  he  deem  me  a  crank  and  try  some  other  doctor 
who  will  give  him  lots  of  medicine?  Judging  the  man  in  the  light 
of  other  cases,  I  do  not  want  him  as  a  patient.  I  have  no  time  for 
making  long  a-b-c  explanations,  and  unless  one  does  explain  so  a 
man  understands  he  will  not  follow  good  advice.  But  unless  I  do 
have  a  "talk"  with  him  how  will  I  be  able  to  get  the  facts  in  the 
case?  He  may  not  be  a  dust  victim  at  all — and  in  that  case  I 
likely  would  not  mention  him  among  cases.  If  he  comes  to  me 
after  "my  book"  is  out  I  can  give  him  a  copy  and  save  a  lot  of 
time. 

Is  it  necessary  to  add  that  "nice  men"  are  put  on  all  tickets — 
to  offset  the  men  who  are  anything  but  nice — no  political  boss 
would  think  of  making  up  a  ticket  wholly  of  his  own  kind. 

The  honest  farmer  or  citizen  who  is  elected  to  office  and  must 

[161 


242  DUSTY   AIE   AND   ILL   HEALTH. 

spend  his  time  under  bad  air  conditions  is  to  be  pitied.  If  there 
were  a  determined  effort  to  have  good  air  at  the  courthouse,  say 
by  electing  a  woman  or  two  who  would  not  tolerate  the  smoker 
and  chewer  and  spitter,  perhaps  there  would  soon  be  a  radical 
difference. 

Case  Report  :  Mrs.  —  called  up  at  a  time  when  my  name  no 
longer  appeared  in  the  telephone  directory  as  a  physician,  asking 
if  I  still  accepted  new  patients.  She  had  been  referred  by  one  of 
my  old  patients,  and  the  very  fact  that  she  had  been  referred  was 
to  me  good  evidence  that,  in  all  probability,  she  was  a  dust  vic- 
tim. Her  language  indicated  that  she  was  above  the  average  in 
intelligence.  She  lived  in  a  good  section  of  town.  Being  childless 
and  in  fairly  good  circumstances  meant  that  she  likely  would  be 
able  to  live  up  to  good  air  advice.  I  asked  her  to  come  in  and  we 
would  talk  over  matters. 

The  woman  gave  a  long  history  of  "not  feeling  well."  Said 
she  was  not  really  sick  but  at  the  same  time  was  not  well,  there 
was  always  something  wrong,  yet  she  was  never  bedfast  but  often 
housefast.  She  had  tried  many  physicians  and  even  specialists  in 
a  large  city.  She  clearly  realized  the  seasonal  influence,  that  she 
got  better  in  the  summer  and  relapsed  in  the  fall.  She  was  in- 
clined to  self-pity,  that  she  could  not  do  as  others.  Moreover  there 
was  a  history  of  tuberculosis  in  one  side  of  her  family  and  she  had 
a  constant  fear  of  consumption. 

She  was  fond  of  flower  gardening  and  on  the  approach  of  cold 
weather  took  in  a  number  of  plants  to  winter  over.  This  gave  me 
a  clew  regarding  explanations.  I  proposed  a  systematic  examina- 
tion and  keeping  a  record,  with  health  supervision,  to  which  she 
agreed.  The  fact  that  I  found  nothing  radically  wrong  of  course 
was  pleasing  but  when  she  asked,  Then  what  is  the  matter?  de- 
tailed explanations  were  necessary.  I  told  her  I  believed  she  was 
a  dust  victim  and  that  if  she  kept  herself  under  observation  and 
reported  occasionally  she  could  soon  verify  it,  which  she  did  in 
the  course  of  time. 


NERVOUS   PROSTRATION.  243 

She  wanted  to  know  how  to  reduce  acute  attacks  to  a  minimum, 
and  if  possible  lay  in  a  stock  of  health  that  would  tide  her  over 
the  late  winter  months  when  she  invariably  ran  down,  during  the 
last  few  years  at  times  reaching  low  ebb.  The  explanation  of 
raising  plants  and  taking  them  into  the  house  on  the  approach  of 
cold  weather  enabled  her  to  understand.  Unless  one  knows  just 
what  to  do  the  plants  will  sicken,  even  die ;  one  must  learn  how 
to  take  care  of  them.  Similarly  people  must  learn  how  to  take  care 
of  children  under  unsanitary  surroundings  or  they  will  perish. 
Likewise  the  individual  must  know  what  to  do  for  himself — among 
other  things  avoiding  five  cent  shows  where  air  conditions  are  very 
bad  or  long  shopping  tours,  such  as  people  make  who  have  lots 
of  time  but  who  buy  little,  shopping  being  a  sort  of  recreation. 
She  protested  that  these  things  did  not  affect  her,  but  her  diary 
soon  convinced  her  that  she  "felt  good"  in  proportion  as  she 
avoided  crowds  and  bad  air. 

This  patient  was  one  of  those  individuals  or  cases  that  are  a 
bugbear  to  the  honest  physician ;  he  does  not  know  what  to  do  and 
is  apt  to  try  all  sorts  of  remedies  and  modes  of  treatment.  When 
such  a  patient  has  made  the  rounds  of  doctors  and  specialists  she 
is  likely  to  be  hypercritical  and  to  question.  Unless  the  physician 
is  willing  to  answer  questions  he  may  find  the  individual  very  dis- 
agreeable, and  still  more  so  if  no  good  results  follow  his  treatment. 

Although  I  promptly  diagnosed  dust  infection  and  regarded 
her  as  a  dust  victim,  yet  for  some  time  I  was  doubtful  to  what 
type  she  belonged.  I  finally  came  to  the  conclusion  she  was  one 
of  those  nervous  individuals  who  ultimately  develop  membranous 
catarrh  of  the  intestines.  Practically  all  her  symptoms  must  be 
regarded  as  warnings,  rarely  is  any  one  sufficiently  severe  to  de- 
mand an  active  remedy.  There  was  more  or  less  complaint  of 
constipation  and  yet  all  she  needed,  besides  good  air,  was  several 
glasses  of  water  a  day.  Occasionally  after  an  acute  exposure 
there  was  an  acute  neuralgic  condition  of  one  side  of  the  face,  for 
which  she  received  a  prescription.    Although  in  the  past  she  had 


244  DUSTY    AIR    AXD    ILL    HEALTH. 

taken  a  lot  of  medicine  and  had  come  to  lose  faith  in  drugs,  yet 
she  was  willing  to  take  medicine,  even  wanted  it. 

She  complained  that  physicians  had  not  been  frank  with  her, 
had  not  freely  discussed  her  symptoms  and  apparently  held  back 
information  from  her  and  on  this  account  she  believed  she  was 
worse  off  than  she  really  was.  She  feared  tuberculosis.  Then 
again  she  expressed  her  belief  that  doctors  were  constantly  experi- 
menting on  her,  trying  new  medicines.  The  most  common  diag- 
nosis was  malaria;  I  advised  her  to  keep  a  record  of  her  tempera- 
ture twice  a  day;  she  was  surprised  to  find  that  this  frequently 
was  subnormal  and  that  the  complaint  of  chilliness  came  on  after 
there  was  an  acute  exposure  to  bad  air.  Because  the  diagnosis  of 
malaria  had  been  such  a  frequent  one,  she  clung  to  this  longest. 
If  physicians  regarded  her  complaints  as  "imaginary"  they  did 
not  tell  her  so — that  is  a  diagnosis  most  commonly  made  only  in 
the  case  of  poor  people. 

There  was  a  complication,  a  serious  one,  that  held  her  back — 
a  catarrhal  husband  constantly  exposed  to  bad  air  who  brought 
infection  to  an  otherwise  clean  home.  It  was  equally  important 
to  advise  and  prescribe  for  him. 

Disease,  III  Health,  Symptoms.  How  shall  one  explain  the 
condition  of  an  individual  who  has  ill  health  rather  than  well- 
defined  disease,  who  reacts  to  his  environment,  and  to  what  extent 
shall  one  speak  of  prevention,  of  avoiding  the  causes  that  produce 
symptoms?  Explanations  depend  largely  upon  the  individual. 
Sometimes  the  explanations  run  along  the  following  lines: 

When  a  man  goes  up  a  high  mountain  he  reacts,  there  is  op- 
pressed breathing,  he  feels  as  if  he  would  suffocate,  he  feels  faint. 
Some  speak  of  the  reaction  as  mountain  sickness.  Shall  we  call  it 
a  disease — "mountain  disease?" 

When  a  man  goes  into  a  dense  smoky  air  he  reacts,  he  feels  as 
if  he  would  suffocate ;  he  coughs  and  sneezes,  his  eyes  water,  mucus 
forms  in  the  air  passages — shall  we  say  he  has  "smoke  disease?" 


NERVOUS   PROSTRATION.  245 

When  a  man  falls  into  the  water  he  reacts,  how  greatly  depends. 
He  may  get  water  into  his  mouth,  he  may  he  paralyzed  from  fear, 
he  may  be  in  great  danger  from  drowning — shall  we  say  he  has  a 
disease?  Is  the  act  of  drowning  a  "disease?"  Today  some  peo- 
ple seem  to  regard  everything  as  a  "disease." 

What  sort  of  aid  would  we  give  a  man  reacting  to  a  rarified 
atmosphere,  to  one  reacting  to  smoky  air,  to  the  one  who  falls  into 
the  water?  To  what  extent  do  we  consider  a  man  in  danger  and 
make  efforts  to  succor  him  ?  What  sort  of  ' '  symptoms"  do  we  con- 
sider indicative  of  danger? 

Perhaps  the  answer  largely  depends  upon  our  own  experiences. 
If  we  are  able  to  swim  we  may  expect  the  man  who  fell  into  the 
water  to  swim  out  or  at  least  keep  his  head  above  water  until  help 
arrives— his  vigorous  kicking  is  not  to  be  regarded  as  a  symptom 
of  drowning  but  as  an  effort  to  save  his  life.  We  are  likely  to 
watch  him,  throw  him  a  life  preserver,  if  not  jump  in  to  his  aid, 
if  help  is  needed.  The  man  who  can  not  swim  would  be  foolish 
to  attempt  a  rescue  by  jumping  in  and  the  man  who  throws  a 
heavy  life  preserver  and  hits  the  swimmer  on  the  head  only  does 
harm. 

Is  the  man  inhaling  smoke  in  danger?  What  are  danger  sig- 
nals, what  are  dangerous  symptoms?  To  what  extent  is  a  rarified 
atmosphere  dangerous?  Would  a  physician  treat  such  a  case 
"symptomatically"  or  would  he  merely  advise  keeping  quiet  and 
as  soon  as  possible  transfer  the  individual  to  a  lower  altitude? 

When  a  man  is  attacked  by  some  wild  beast  he  is  apt  to  make 
a  vigorous  defense.  Should  we  call  the  reaction  a  disease,  and 
should  we  regard  his  efforts  to  save  himself  as  symptoms  indicat- 
ive of  danger,  or  do  they  show  that  the  man  is  successfully  fight- 
ing off  the  enemy  ?  Is  it  not  true  that  danger  appears  or  increases 
as  a  man  fights  less  vigorously,  as  he  gets  faint,  exhausted,  when 
the  reaction,  i.e.  "symptoms,"  is  less  marked? 

When  a  man  is  attacked  by  myriads  of  microbes  his  body  re- 
acts, there  is  an  active  fight.    To  what  extent  shall  we  aid  the  man 


246  DUSTY   AIR   AND    ILL    HEALTH. 

attacked?  Do  we  know  what  he  needs?  Fever  is  an  index  of  the 
heat  of  battle — are  we  aiding  a  man  if  we  give  him  something  to 
"reduce  the  fever?" 

A  long  time  ago  a  cynic  defined  a  physician  as  a  man  who  pours 
drugs  about  which  he  knows  little  into  a  body  about  which  he 
knows  less.  But  physicians  in  the  course  of  time  have  learned  a 
lot  about  the  human  body  and  about  drugs,  including  their  worth- 
lessness  to  cure  and  their  value  in  palliating  symptoms  as  well  as 
in  discriminating  between  symptoms — those  that  threaten  life  and 
those  that  merely  indicate  that  the  body  is  reacting  vigorously  in 
"throwing  off  the  disease,"  in  getting  rid  of  infection. 

Many  physicians  use  simple  remedies  and  get  results — they 
know  just  when  to  use  them  to  turn  the  balance  in  our  favor. 
When  a  physician  is  sick  he  does  not  prescribe  for  himself;  he 
keeps  in  mind  the  old  saying,  A  man  who  prescribes  for  himself 
has  a  fool  for  a  patient.  Lawyers  have  a  similar  saying.  But  in 
the  case  of  symptoms  not  due  to  the  presence  of  real  disease  he 
likely  has  discovered  what  will  help  him  and  he  may  not  be  above 
taking  his  own  medicine.  If  the  people  knew  how  little  medicine 
a  physician  takes  and  how  little  he  gives  his  relatives  and  friends 
and  his  old  patients  they  would  carefully  consider  the  indiscrim- 
inate use  of  drugs. 

To  what  extent  are  drugs  of  value  in  dust  infection?  Such  a 
question  opens  up  a  wide  field  for  discussion.  Here  I  will  merely 
say  drugs  may  help  but  can  not  be  considered  in  the  light  of 
' '  cures. ' ' 

Among  my  early  patients  was  a  servant  girl  with  sore  hands, 
the  skin  was  scaly,  cracked  and  occasionally  suppurated.  She  had 
used  all  sorts  of  salves,  ointments  and  lotions.  I  told  her  the  most 
important  thing  to  do  was  to  keep  her  hands  out  of  water.  But 
how  was  she  to  do  that;  she  had  to  work?  Could  I  write  her  a 
prescription?  I  did  write  her  one  for  a  greasy  mixture,  explain- 
ing that  it  would  be  effective  only  if  the  hands  were  kept  dry.  T 
did  not  see  her  again  for  several  years  and  then  I  learned  that  she 
continued  to  have  sore  hands  for  a  long  time  because  she  had  to 


NERVOUS    PROSTRATION.  247 

put  them  in  water  more  or  less.  After  getting  married  when  she 
"could  take  it  easy"  she  was  able  to  live  up  to  keep-your-hands- 
out-of-water  advice  and  then  her  hands  soon  got  well. 

Another  early  patient  was  a  man  who  worked  with  moist  ce- 
ment, he  had  sore  hands  that  he  vainly  tried  to  heal  by  the  use 
of  medicines.  I  advised  a  change  of  occupation.  I  did  not  see  him 
again  for  nearly  ten  years,  when  one  day  he  greeted  me  on  the 
street.  At  first  I  failed  to  recognize  him,  he  was  thin,  sallow  and 
hollow-eyed,  with  suffering  written  on  his  face.  I  learned  that  he 
had  gone  to  a  large  city  soon  after  he  had  consulted  me,  his  hands 
improved  at  once — but  gradually  his  chest  began  to  ache  and 
finally  he  came  to  the  conclusion  that  the  dusty  city  air  did  not 
agree  with  him ;  it  choked  him  and  made  him  cough.  As  a  matter 
of  fact  ten  years  of  city  life  had  exhausted  him.  Is  it  necessary 
to  say  that  the  man  in  addition  to  advice  to  keep  his  hands  away 
from  irritants  should  also  have  had  good  air  advice,  to  keep  his 
nose  out  of  bad  air? 

Frequently  I  have  occasion  to  advise  hay-fever  victims,  and 
if  they  get  any  prescription  it  is  one  that  may  palliate;  the  "cure" 
consists  in  change  of  air.  Old  hay-fever  victims  have  fully  learned 
this  lesson,  they  smile  at  those  seeking  a  "cure"  by  the  use  of 
drugs. 

The  man  who  wants  to  avoid  the  effects  of  rarified  mountain 
air,  of  smoky  air,  will  keep  away — just  as  the  dust  victim  will 
keep  away  from  dusty  air. 

Should  a  Patient  be  Told  the  Truth?  The  patient  had 
questioned  whether  she  was  being  told  the  truth  by  physicians; 
that  led  to  a  lengthy  discussion.  I  explained  to  her  that  in  case 
I  had  found  tuberculosis  the  question  of  telling  the  truth  would 
have  assumed  a  different  aspect  than  where  there  is  no  well-defined 
disease;  that  had  tuberculosis  been  present  I  likely  would  first 
have  discussed  the  matter  with  her  husband,  but  since  she  is  only 
a  dust  victim  I  had  at  once  discussed  conditions  or  findings  with 
her.  There  was  no  need  at  all  for  concealing  the  truth,  she  ought 
to  know  the  truth.    "The  truth  shall  make  you  free." 


248  DUSTY    AIR   AND    ILL    HEALTH. 

But,  a  physician  told  me,  by  speaking  of  dust  influences  pa- 
tients, especially  the  active  minded,  may  imagine  effects  after  an 
exposure,  symptoms  may  be  purely  imaginary.  The  best  reply  I 
can  make  to  such  a  remark  is:  Study  your  own  cases,  withhold 
the  information  that  the  patient  is  a  dust  victim  as  long  as  you 
desire,  until  satisfied  that  dust  influences  are  real  or  "purely 
imaginary."  I  have  satisfied  myself  over  and  over  that  they  are 
real. 

Such  patients  will  naturally  ask  one's  opinion  of  other  physi- 
cians. Here  is  dangerous  ground,  for  patients  will  "talk"  and 
one  may  get  an  undesirable  reputation  among  fellow-practitioners. 
Under  such  conditions  the  physician  had  best  get  the  patient's 
view  and  avoid  expressing  his  own.  It  certainly  would  not  be 
proper  in  a  volume  of  this  kind  to  give  any  derogatory  opinions 
against  physicians  who  honestly  try  to  help  their  patients  and  are 
working  in  the  best  light  they  have.  But  what  shall  be  said  of 
the  doctor  who  has  so  little  esprit  de  corps,  so  little  pride  in  his 
profession,  that  he  does  not  belong  to  his  county  medical  society 
where  things  of  common  interest  are  discussed  and  where  physi- 
cians learn  to  know  each  other  and  their  abilities  and  capabilities? 
Is  it  the  physician's  duty  to  expose  such  men,  men  who  readily 
promise  to  cure  what  no  conscientious  physician  can  cure?  Here 
I  end  as  I  began,  should  a  patient  be  told  the  truth  ? 

Experimenting  and  Being  Experimented  Upon.  The  pa- 
tient's remarks  of  being  experimented  upon  should  also  be  con- 
sidered. The  subject  is  one  that  could  be  discussed  at  great  length. 
One  would  have  to  go  back  to  the  early  days  when  physicians  had 
practically  no  knowledge  of  the  workings  of  the  human  body,  when 
they  tried  all  sorts  of  things  in  the  hope  of  "driving  out"  disease. 
Then  we  must  consider  the  fact  that  in  proportion  as  men  have 
few  facts  they  are  apt  to  spin  elaborate  theories.  Properly  speak- 
ing there  was  no  medical  science  until  about  three  hundred  years 
ago  when  with  the  revival  of  learning  the  experimental  method  in 
science  arose.  Up  to  that  time  the  circulation  of  the  blood  was 
not  even  known.     Today  the  experimental  method  has  reached  a 


NERVOUS    PROSTRATION.  249 

wonderful  development.  There  are  even  journals  devoted  to  "ex- 
perimental medicine." 

But  medical  men  who  experiment  are  comparatively  few.  They 
are  usually  college  and  hospital  men.  The  average  physician  is 
not  an  experimenter,  properly  speaking,  just  the  opposite.  He 
even  hesitates  to  try  new  remedies  unless  they  are  backed  by  au- 
thorities. But  there  are  not  lacking  physicians,  especially  those 
who  lack  a  grounding  in  the  sciences  on  which  medicine  rests,  who 
are  ready  to  try  anything  and  everything  in  the  hope  of  curing, 
without  perhaps  a  proper  conception  of  what  they  are  attempting 
to  cure.  Some  physicians  give  "alteratives"  but  they  have  a 
very  hazy  idea  of  what  they  really  are  trying  to  alter.  Similarly 
they  give  tonics  without  understanding  the  needs  of  the  body.  I 
am  reminded  of  a  recent  occurrence. 

A  friendly  druggist  gave  me  a  sample  package  of  a  "laying 
tonic"  for  hens.  The  package  says,  "It  insures  egg  laying  with- 
out forcing,  is  absolutely  harmless  and  promotes  health.  Try  it 
at  our  expense;  enough  for  six  hens  for  twenty-one  days."  A 
poultry  book  accompanied  the  sample,  which  told  how  to  build  a 
properly  lighted,  drained  and  well  ventilated  chicken  house,  in 
fact,  giving  much  good  advice  regarding  the  care  of  chickens. 
Here  are  the  directions  given  for  using  the  sample  of  "laying 
tonic": 

"First  separate  six  fowls  for  the  test.  Put  1  level  teaspoonful  into 
1  pint  of  mash  feed.  Besides  this,  feed  dry  grains  liberally  twice  a  day 
in  a  6-inch  deep  litter,  so  that  fowls  will  work  for  it.  Keep  oyster  shell, 
grit,  beef  scrap  and  pure  water  constantly  before  them. 

"A  good  mash  can  be  made  as  follows :  For  cold  weather — October 
to  late  spring — feed  mash  first  thing  in  the  morning.  Two  parts  cut  alfalfa 
or  clover,  two  parts  mixed  feed  or  wheat  bran,  two  parts  cornmeal,  one 
part  green  cut  bone  or  beef  scrap,  one  part  table  scraps.  Add  a  little 
salt.  Add  boiling  water  in  sufficient  quantity  to  moisten  every  portion 
without  making  it  sloppy  or  sticky.     Cool  somewhat  before  feeding." 

Is  any  one  who  separates  six  fowls  and  follows  these  directions 
experimenting  ?  One  of  the  first  rules  for  experimenting  is  to  vary 
only  one  factor  at  a  time,  otherwise  one  can  not  draw  proper  con- 
clusions. 


250  DUSTY    ATR    AND    ILL    HEALTH. 

Suppose  a  man  is  not  feeling  well,  that  he  "needed  a  tonic," 
and  that  the  doctor  gave  him  a  prescription,  with  elaborate  direc- 
tions how  to  take.  Now  every  physician  knows  that  what  people 
need  is  an  abundance  of  good  food  and  proper  housing — the 
"tonic"  has  little  or  nothing  to  do  with  it.  But  some  people  are 
so  obtuse  that  they  do  not  understand  these  things,  and  when  they 
feel  better  the  medicine  is  given  the  credit. 

I  occasionally  see  chickens  cooped  up,  with  a  little  runway, 
perhaps  composed  of  cinders,  with  nothing  green  in  sight.  Twice 
a  day  some  corn  is  thrown  in.  It  is  an  utter  impossibility  for  any 
"laying  tonic''  to  make  them  lay.  I  similarly  know  people  who 
are  in  want  of  food  and  fire,  indeed  of  proper  housing,  and  yet 
when  they  come  complaining  to  a  physician  they  may  be  given  a 
tonic.  If  such  people  do  not  get  well  after  trying  different  tonics 
and  different  medicines  can  they  properly  accuse  the  doctors  of 
experimenting?  Why  doctors  merely  hand  out  a  little  medicine 
instead  of  properly  investigating  and  pointing  out  things  is  another 
question.  Shall  we  say  that  if  people  expect  little  of  the  doctors 
they  get  little?  If  a  patient  insists  on  a  tonic  she  will  likely  get 
one. 

There  is  another  side  to  the  question  of  experimenting.  The 
physician  in  private  practice  can  not  afford  to  have  the  reputation 
of  experimenting  on  his  patients.  Just  how  often  a  physician  can 
"change  the  medicine"  without  getting  the  reputation  of  being  an 
experimenter,  is  of  course  an  open  question.  But  aside  from  giving 
medicine  anything  out  of  the  usual  is  apt  to  be  regarded  in  the 
light  of  an  experiment  and  if  the  patient  does  not  clearly  under- 
stand the  why  and  the  wherefore  he  is  apt  to  regard  himself  as  an 
experimenter. 

But  frequently  patients  themselves  want  to  experiment,  or 
rather  they  want  "experimental  evidence"  that  they  are  not  dust 
victims.  I  tell  such  a  patient  that  after  all  the  assumption  that 
he  is  a  dust  victim  may  not  be  true,  that  one  goes  largely  by  an- 
alogy, judging  one  by  another,  and  that  if  he  wants  to  experiment, 
why  there  is  nothing  to  prevent  him.    I  do  not  advise  dust  victims 


NERVOUS   PROSTRATION.  251 

to  experiment  by  wilfully  exposing  themselves,  hut  if  they  want 
to  do  so  I  ask  them  to  enter  the  experiment  on  their  record  and 
tell  me  about  it.  The  dust  victim  soon  finds  that  it  does  not  pay 
to  experiment,  that  there  are  enough  unavoidable  exposures  to 
show  him  that  dust  infection  is  a  reality. 

In  connection  with  the  last  mentioned  patient  fears  and  phobias 
should  also  be  mentioned. 

Fears  and  Phobias.  Individuals  who  are  classed  as  neuras- 
theniacs,  especially  those  who  have  active  minds,  are  subject  to 
all  sorts  of  fears,  at  times  to  phobias.  Fear  is  inborn  and  may  be 
said  to  have  a  good  foundation,  phobias  are  excessive  fears  often 
lacking  substantial  ground.  Phobias  may  shade  off  into  insanity. 
Fear  is  an  instinct;  in  proportion  as  we  fear  and  avoid  dangers 
we  are  apt  to  survive.  Fear  shades  off  into  worry,  especially  where 
the  individual  does  not  reason  about  causes.  Take,  for  instance, 
the  neurastheniac  who  complains  of  pains  in  the  chest  and  fears 
tuberculosis.  He  may  lie  awake  at  night  and  worry.  This  is  es- 
pecially true  in  those  who  have  had  a  death  in  the  family  or  among 
relatives  from  tuberculosis.  The  same  is  true  again  of  individuals 
who  have  a  pain,  perhaps  a  recurrent  pain,  in  the  region  of  the 
stomach.  They  fear  cancer  of  the  stomach,  just  as  another  may 
be  led  to  fear  heart  disease  or  kidney  disease.  Now  as  a  rule  the 
pains  and  aches  of  the  neurastheniac  are  due  to  environmental  in- 
fluences rather  than  to  disease  or  the  beginnings  of  disease,  and 
when  the  matter  is  properly  explained  (especially  if  the  individual 
is  a  dust  victim)  they  dismiss  the  subject  and  no  longer  lie  awake 
at  night  wondering  what  it  all  means. 

Dust  Fear.  When  I  first  realized  the  possibility  of  infected 
dust  I  developed  a  "dust  fear,"  but  in  the  course  of  years  I  came 
to  the  conclusion  that  the  very  fact  that  I  was  alive  showed  that 
after  all  one's  fears  may  be  largely  groundless.  As  one  develops 
a  good  air  conscience  one  naturally  avoids  places  where  the  air  is 
suspected  and  under  good  air  conditions  dust  fear  may  not  come 
into  consciousness  at  all. 


252  DUSTY    AIR    AND    ILL    HEALTH. 

When  I  first  began  to  discuss  these  things  I  now  and  then  met 
individuals  who  developed  a  similar  dust  fear,  or  to  give  it  a  tech- 
nical name,  Conophobia,  I  can  now  see  that  often  it  was  my  fault 
that  this  happened,  that  I  did  not  fully  explain.  In  attempting 
to  show  the  dangers  of  dust  one  should  also  explain  that  the  very 
fact  that  the  individual  is  still  alive  shows  that  he  has  escaped  all 
sorts  of  dangers  and  now  that  he  is  warned  he  will  likely  suffer 
less  than  in  the  past.     To  be  forewarned  is  to  be  forearmed. 

To  cultivate  a  healthy  fear  of  dust  and  to  acquire  a  good  air 
conscience  and  avoid  worrying  are  worth  while.  It  may  even  be 
desirable  to  make  a  radical  change  of  one's  surroundings.  As  a 
matter  of  fact  every  now  and  then  some  of  my  "best  patients" 
leave  the  community,  following  my  advice  to  get  better  air. 

In  discussing  this  subject  one  of  my  patients  related  an  experi- 
ence that  shows  the  genesis  of  fear  and  his  attempts  to  get  rid  of 
worry.  When  Mr.  —  reached  the  age  of  puberty  he  began  to  go 
to  the  barber.  He  went  for  several  years;  occasionally  there  was 
a  little  scratch  or  a  cut  on  the  face  or  a  pimple  would  appear,  but 
he  never  paid  attention  to  them.  Then  one  day  a  little  cut  was 
followed  by  barber's  itch  and  he  had  a  serious  time  in  getting  rid 
of  it.  After  that  he  was  apprehensive  of  every  little  scratch  or 
pimple.  He  was  in  constant  dread  of  barber's  itch.  About  that 
time  safety  razors  came  on  the  market  and  he  promptly  got  one 
and  shaved  himself.  Then  all  fear  of  barber's  itch  vanished,  ex- 
cept, for  a  short  time  each  month  when  he  went  to  the  barber  to 
have  his  hair  cut  and  get  shaved.  Then  he  again  carefully  watched 
his  face  and  always  looked  for  the  worst.  Finally  he  decided  to 
shave  himself  even  at  the  time  of  the  monthly  hair  cutting. 

Hospital  Physicians  and  Physicians  in  Private  Practice. 
For  several  years  I  was  physician  among  the  insane,  and  that 
means  among  other  things  that  one  does  not  have  to  look  after  the 
financial  side  of  the  practice  of  medicine,  and  it  means,  too,  that 
one  can  give  an  individual  much  time  and  attention  wholly  with- 
out any  thought  of  getting  any  returns.     Occasionally  some  of  my 


NERVOUS   PROSTRATION.  253 

old  hospital  patients  come  in  for  advice,  perhaps  under  the  im- 
pression that  I  still  have  lots  of  time  and  will  discuss  things  in 
detail. 

I  recall  a  young  man,  one  of  my  former  hospital  patients,  who 
consulted  me  regarding  the  question  of  getting  married  and  start- 
ing a  store  in  a  small  county-seat.  He  complained  of  the  scant 
attention  his  home  physician  gave  him  (he  came  from  a  distant 
county)  and  remarked  on  the  difference  between  hospital  physi- 
cians and  those  "on  the  outside,"  that  the  latter  had  little  time 
or  took  little  time  for  discussion,  and  that  some  spoke  dogmatically, 
as  though  there  were  only  one  side  to  a  question.  I  had  to  point 
out  that  strictly  speaking  his  "case"  was  scarcely  one  for  the 
ordinary  physician,  that  the  general  practitioner  was  concerned 
with  ills,  with  ' '  treating  the  sick ' '  and  that  ■  many  are  so  busy 
doing  this  that  they  have  no  time  to  discuss  such  problems. 

The  man  who  has  once  been  in  an  insane  hospital  and  then 
thinks  of  getting  married  may  be  confronted  with  all  sorts  of 
questions,  especially  in  the  small  village  where  everybody  knows 
everybody  else  and  where  people  are  suspicious  of  a  man  "re- 
lapsing, ' '  of  becoming  insane  again,  although  the  chances  of  doing 
so  may  be  very  remote. 

This  young  man  had  a  mate  in  view  but  had  never  sounded 
her  regarding  her  views  of  marrying  a  man  who  had  been  in  an 
insane  hospital,  he  was  too  conscientious  to  attempt  concealment. 

Now  I  myself  was  very  busy  at  the  time  and  I  too  was  "on  the 
outside. ' '  I  was  no  longer  a  hospital  physician  with  lots  of  time  to 
discuss  topics  of  remote  interest  to  me.  To  what  extent  does  one 
express  himself  dogmatically  under  such  conditions? 

But  there  was  one  aspect  of  the  question  that  was  of  interest 
to  me.  The  man  had  a  rural  ancestry  and  had  always  lived  on 
the  farm.  When  he  tried  town  life  he  reacted,  mentally,  and  then 
was  sent  to  the  insane  hospital.  If  he  now  went  to  live  in  town 
would  he  fail  again?  This  was  a  question  to  which  I  was  willing 
to  give  time.  I  strongly  advised  against  leaving  the  farm,  and  in 
the  light  of  what  is  said  in  this  volume  the  reasons  must  be  clear. 


254  DUSTY    ATE    AND    ILL    HEALTH. 

At  the  same  time  I  told  him  if  he  did  go  to  live  in  town  in  spite 
of  my  advice  to  keep  me  informed — I  was  after  data,  of  course. 
What  the  ultimate  outcome  was  I  do  not  know. 

I  charged  the  young  man  a  small  fee  (two  dollars,  one-fifth  of 
what  he  told  me  he  had  expected  to  pay),  and  he  again  spoke  of 
the  difference  between  hospital  doctors  and  those  on  the  outside — 
he  evidently  still  regarded  me  as  a  "hospital  doctor,"  although  I 
was  in  private  practice.  I  pointed  out  how  men  chose  hospital 
positions.  Some  went  on  account  of  the  practical  experience,  a  few 
followed  it  as  a  career.  (Most  men  get  tired  in  a  year  or  two  on 
account  of  the  monotony — one  knows  for  months  and  for  years  in 
advance  what  sort  of  cases  come  before  him,  monotony  palls.) 
Some  went  on  account  of  the  opportunity  to  save  enough  so  they 
can  "stand  it  for  a  time"  while  waiting  for  patients  in  private 
practice.  (I  belonged  mainly  to  this  group.)  Some  men  disgusted 
with  the  private  practice  of  medicine  preferred  to  have  a  salaried 
position  and  have  no  concern  about  the  matter  of  fees  at  all. 

He  had  never  thought  of  these  things — nor  have  many  others. 
The  "outside  physicians"  must  more  or  less  constantly  consider 
the  bread  and  butter  aspect  of  the  practice  of  medicine.  Is  it  any 
wonder  that  the  general  practitioner  gives  some  people  scant  at- 
tention? And  is  it  any  wonder  that  many  refuse  to  enter  into 
movements  looking  to  municipal  or  civic  improvements?  Matters 
of  purely  civic  importance  are  only  too  often  made  matters  of 
politics  and  people  take  sides — and  get  abuse.  Many  physicians 
do  not  care  to  do  anything  that  does  not  naturally  fall  within 
their  professional  spheres — and  to  some  that  sphere  is  a  very  nar- 
row one. 

Every  now  and  then  we  read  about  the  "wonderful  advance 
of  medicine"  or  of  sanitary  science.  We  are  told  what  the  gov- 
ernment has  done  in  Panama,  in  Cuba,  and  in  the  Philippines, 
how  it  has  altered  unsanitary  surroundings  and  reduced  the  death 
rate.  And  then  some  people  wonder  why  the  government  does  not 
interest  itself  in  people  nearer  home. 

When  one  considers  to  what  extent  the  insane  in  our  State 


NERVOUS   PROSTRATION.  255 

institutions  are  made  comfortable  and  ill  health  is  prevented,  one 
begins  to  realize  how  much  a  community  could  do,  especially  for 
the  poor  who  are  a  constant  foci  of  infection  to  others. 

Medical  Supervision.  Health  Supervision.  One  of  my  old 
patients  years  ago  while  living  under  city  conditions  had  much  ill 
health  but  while  employed  about  an  insane  hospital  had  good 
health.  On  going  back  to  city  life  his  health  again  failed;  when 
he  came  to  me  he  thought  his  time  was  up.  The  one  factor  that 
he  had  to  consider  was  the  air  factor.  Country  life  soon  set  him 
up  and  then  he  again  got  employment  at  the  insane  hospital  and 
here  at  the  same  time  he  was  under  medical  supervision,  that  is 
he  was  daily  seen  by  the  hospital  physicians  who  gave  him  timely 
attention.  As  a  consequence  his  health  is  now  better  than  it  had 
been  for  many  years;  one  may  say  he  has  taken  a  new  lease  on 
life. 

If  there  is  one  thing  that  is  given  careful  attention  at  that 
hospital  it  is  air  conditions,  as  I  know  from  many  years'  close  ob- 
servation, and  on  this  account  the  common  ailments,  so  prevalent 
in  the  nearby  town  during  the  closed  door  season,  are  practically 
absent. 

The  subject  of  health  supervision  will  be  considered  in  con- 
nection with  cardio-vascular  cases  to  be  cited  later.  I  may  here 
say  that  for  some  time  I  have  been  giving  special  attention  to  such 
cases  particularly  from  the  standpoint  of  health  supervision,  of 
preventing  ill  health  or  symptoms  of  ill  health,  and  shall  I  say 
symptoms  of  old  age?  The  term  refers  to  changes  in  the  heart 
and  blood  vessels. 

Choosing  a  title  for  this  volume  has  been  a  puzzle.  Since  this 
volume  is  intended  for  people  in  ill  health,  the  title  should  show 
this,  and  yet  it  should  not  be  one  that  is  repellant  or  that  limits 
the  field  too  closely,  and  on  the  other  hand  it  should  not  be  so 
broad  as  to  deceive  the  man  who  really  is  not  concerned  in  the 
subject  of  ill  health. 


256  DUSTY    AIR    AND    ILL    HEALTH. 

I  have  in  mind  a  volume  that  recently  appeared,  "Old  Age 
Deferred."  It  is  really  a  volume  that  appeals  to  a  limited  num- 
ber of  physicians,  and  yet  the  title,  as  well  as  parts  of  the  book, 
appeals  to  nearly  everybody.  But  after  all  the  one  great  factor 
that  our  people,  in  contrast  to  European  people,  have  to  guard 
against  is  practically  not  mentioned  at  all.  This  is  the  factor  I 
am  trying  to  bring  out  in  this  volume. 

People  in  chronic  ill  health  often  live  on  to  old  age,  but  it  is  a 
life  of  more  or  less  constant  misery.  I  am  trying  to  tell,  particu- 
larly the  "old  chronics,"  how  to  reduce  symptoms,  pains  and 
aches  of  all  kinds,  to  a  minimum.  Moreover  I  am  not  concerned 
with  complicated  directions  that  only  a  rich  man  can  follow,  but 
with  simple  advice  which  practically  any  one  can  follow,  but  of 
course  only  fully  by  those  who  are  really  able  to  take  care  of 
themselves,  with  all  that  that  implies. 

We  hear  of  the  formation  of  Century  Clubs — among  men. 
Many  men  are  willing,  indeed  anxious,  to  live  a  hundred  years, 
but  we  do  not  hear  of  women  giving  expression  to  such  a  thought. 
They  would  rather  not  live  so  long  but  lead  a  full  life,  a  life  with 
a  minimum  of  ill  health.  They  would  rather  live  a  full  life  than 
a  long  life.  Many  people  who  reach  old  age  do  not  enjoy  life, 
and,  most  important,  do  not  make  life  pleasant  for  those  about 
them.  Would  it  not  be  best  for  the  men  also  to  seek  a  full  life 
rather  than  a  long  life?  "Old  Age  Deferred."  That  title  ap- 
peals to  every  one.  Old  age  is  something  we  like  to  ward  off. 
After  all  it  may  not  be  measured  by  years.  Some  men  are  old 
at  forty,  others  are  young  at  seventy,  well  expressed  by  the  old 
saying,  A  man  is  as  old  as  his  arteries,  in  fact,  he  is  as  old  as  his 
weakest  organ — it  may  be  the  thyroid  gland  or  it  may  be  the 
"nuciform  gland"?  I  have  no  desire  to  criticise  that  volume 
but  I  do  wish  to  say  that  many  are  misled  by  the  title.  It  is  not 
a  popular  volume  and  indeed  is  of  value  only  to  physicians  and 
not  even  to  every  physician.  It  is  a  translation  of  a  German  book, 
written  by  a  physician  who  practices  at  a  fashionable  German 
health  resort,  one  patronized  only  by  rich  people,  those  who  can 


NERVOUS   1PROSTTUTTON.  257 

afford  the  best  that  Medicine  has  to  give.  Although  the  influence 
of  "good  air"  is  repeatedly  mentioned,  to  say  emphatically  that 
everybody  should  live  on  the  edge  of  town  or  have  his  own  park 
or  bit  of  woodland  must  be  regarded  as  a  ridiculous  solution.  How 
many  people  can  live  up  to  such  advice?  And  that  brings  us 
back  to  the  old  question.    What  is  good  air?    What  is  its  opposite? 

Moreover  a  poor  man  can  not  afford  to  have  a  physician  look 
him  over  at  short  intervals  and  give  timely  advice,  he  must  do  the 
best  he  can  under  limited  circumstances.  And  yet  if  he  properly 
understands  the  subject  he  can  accomplish  much  in  reducing  his 
symptoms  of  ill  health  to  a  minimum;  he  will  always  find  physi- 
cians at  home,  acquainted  with  local  conditions,  who  will  help  him. 

I  end  as  I  began,  choosing  a  title  for  this  volume  has  been  a 
puzzle. 


U71 


VII. 

CARDIO-VASCULAR  AFFECTIONS 

OR   HEART   AND  KIDNEY  CASES. 


In  the  eases  so  far  mentioned  the  physician  can  not  accurately 
if  at  all  predict  the  outcome.  The  individual,  the  patient,  may  die 
early  or  he  may  long  outlive  the  physician  who  perhaps  predicted 
an  early  death  on  insufficient  grounds.  There  may  be,  and  usually 
are,  many  factors  to  be  considered.  Prudent  people  who  take  care 
of  themselves  and  heed  warnings,  that  is  symptoms,  are  apt  to  live 
on  and  on,  perhaps  die  of  "old  age"  (this  however  usually  means 
some  "terminal  infection").  Others  go  ahead  and  take  no  time  to 
rest  or  to  give  nature  a  chance  to  overcome  infection  or  attacks  of 
ill  health;  some  disease  appears  and  terminates  life.  There  is  much 
truth  in  the  old  saying,  Acquire  an  incurable  disease  and  live  long, 
only  we  must  know  what  that  means.  Usually  there  is  no  disease 
at  all,  only  ill  health  not  arising  to  the  dignity  of  disease.  It  is 
usuall}'  old  chronics  who  live  long,  the  robust  go  to  pieces  quickly 
and  prematurely,  especially  under  unsanitary  city  conditions. 

In  general  one  may  divide  individuals  into  three  great  groups 
according  to  the  blood  pressure,  those  with  a  low  pressure,  those 
with  a  medium  pressure,  those  with  a  high  pressure.  The  average 
individual  in  health  has  a  medium  pressure ;  if  the  physician  wants 
to  study  him  he  must  look  him  up.  People  with  low  pressure  tend 
to  end  especially  in  such  diseases  as  consumption  and  catarrhal 
pneumonia.  Low  blood  pressure  however  is  not  incompatible  with 
long  life,  if  care  is  taken  to  keep  away  from  infection,  to  live 
under  good  surroundings  and  heed  symptoms  or  warnings.  High 
blood  pressure  on  the  other  hand  tends  to  so-called  cardio-vascular 
affections,  especially  heart  and  kidney  diseases,  in  apoplexies,  par- 
alyses and  Bright 's  disease.  It  is  in  high  pressure  cases  that  the 
physician  can  often  pretty  accurately  predict  the  outcome. 

The  increase  in  recent  years  of  heart  and  kidney  diseases  has 

(268) 


C AUDIO- VASCULAR  AFFECTIONS.  259 

become  quite  noticeable.  But  we  must  consider  that  many  other 
diseases  have  greatly  diminished.  Some  of  the  formerly  great  epi- 
demic diseases  no  longer  occur  at  all  among  us ;  they  are  kept 
away.  While  writing  these  notes  cholera  is  being  kept  out  of  our 
country.  In  the  end  of  course  all  must  die,  if  not  from  one  cause 
or  disease  then  from  another,  and  yet  when  all  factors  are  con- 
sidered the  increase  in  heart  and  kidney  diseases  stands  out,  no- 
ticeably among  people  who  are  young  in  years.  One  may  naturally 
expect  a  giving  out  of  parts  of  the  body,  of  blood  vessels,  for 
instance,  in  old  people,  but  one  would  not  expect  this  in  those  who 
are  still  comparatively  young.  Acute  specific  disease  may  of 
course  attack  persons  of  any  age  and  carry  them  off,  but  as  a  rule 
apoplexy  and  paralyses  and  Bright 's  disease  are  not  classed  among 
the  acute  specific  diseases ;  they  are  ordinarily  not  considered  as 
having  any  connection  with  "germs." 

Symptoms  are  commonly  divided,  as  stated  above,  into  sub- 
jective and  objective,  those  that  we  ourselves  feel  and  those  that 
we  can  see  in  others.  We  may  have  a  headache  or  feel  nauseated, 
but  unless  we  tell  another  of  it  he  would  not  know  it.  We  must 
take  a  man's  word  for  the  things,  symptoms,  we  can  not  see;  such 
symptoms  are  subjective.  Cough  and  vomiting  on  the  other  hand 
are  objective  symptoms,  or  signs. 

At  times  a  man  will  say  he  feels  feverish,  and  yet  the  ther- 
mometer may  fail  to  show  any  elevation  of  temperature,  he  feels 
so  only.  A  man  may  complain  of  being  sick  and  yet  the  most 
skilled  physician  may  fail  to  find  any  evidence  of  disease.  There 
may  be  only  a  transitory  reaction. 

Again  a  man  may  say  he  has  the  "best  of  health."  He  applies 
for  life  insurance;  he  may  pass  a  good  examination — until  the 
urine  is  examined  and  the  blood  pressure  is  taken,  then  he  may  be 
rejected  promptly.  He  may  be  wholly  unaware  that  he  has  al- 
bumin in  the  urine  or  that  he  has  a  high  blood  pressure  and  that 
there  is  danger  of  a  sudden  termination  of  his  life.  Unless  such 
a  man  is  examined  by  a  competent  physician  he  may  not  learn 
about  his  condition  at  all. 


260  DUSTY   AIR  AND  ILL   HEALTH. 

Does  the  presence  of  albumin  in  the  urine  constitute  a  disease 
or  is  it  merely  a  symptom  or  an  indication  of  disordered  function- 
ing*/ The  same  question  may  be  asked  regarding  a  high  blood 
pressure.  Various  causes  may  bring  on  such  symptoms  and  yet 
the  physician  may  hesitate  to  speak  of  disease.  Often  it  is  a  mat- 
ter of  quantity.  A  trace  of  albumin  or  a  slight  elevation  of  pres- 
sure may  be  disregarded  as  not  signifying  anything;  much  albumin 
or  a  very  high  blood  pressure  indicates  danger.  When  does  health 
shade  off  into  ill  health  and  into  disease  and  finally  into  death? 
To  what  extent  do  data  enable  us  to  predict?  Prediction  is  the 
test  of  science. 

All  sorts  of  people,  patients,  come  before  the  physician.  All 
complain  in  some  way  or  other.  Why  should  they  come  to  him 
unless  there  is  something  the  matter?  Unfortunately  the  doctor 
has  no  instrument  to  test  the  presence  of  pain  and  its  intensity, 
he  must  take  the  patient's  word  for  it,  just  as  the  patient  must 
take  the  doctor's  word  for  it  that  albumin  and  a  high  blood  pres- 
sure are  present;  exceptionally  he  may  demonstrate  their  pres- 
ence, as  to  the  man  who  has  had  high  school  or  college  labora- 
tory work.  Some  patients  find  it  difficult  to  convince  the  doctor 
that  there  is  something  the  matter;  they  will  not  believe  the  doc- 
tor who  tells  them  that  it  is  all  imaginary — just  as  the  doctor  finds 
it  difficult  to  impress  some  men  that  there  is  something  the  matter, 
as  when  he  examines  a  supposedly  healthy  man  for  life  insurance 
and  finds  albumin  and  a  high  blood  pressure. 

Some  people  are  constantly  running  after  the  doctor  for  all 
sorts  of  trivial  complaints,  often  mere  symptoms  of  discomfort,  and 
so  in  the  end  the  doctor  may  tell  his  patient  to  ignore  slight  com- 
plaints, that  there  is  nothing  the  matter,  meaning  ' '  nothing  organic 
the  matter."  At  the  other  extreme  again  are  people  who  refuse 
to  consult  the  physician  at  all,  although  there  may  be  something 
radically  wrong,  the  man,  as  just  mentioned,  with  albumin  and  a 
high  blood  pressure,  perhaps  in  imminent  danger  of  death  from 
"heart  disease"  or  "kidney  diseases,"  either  one  or  both  combined. 

There  are  all   kinds  of  symptoms  of  perverted   or   abnormal 


CARDIOVASCULAR   AFFECTIONS.  261 

functioning  of  the  organs  of  the  body.  When  we  feel  perfectly 
well  or  healthy  there  are  no  symptoms,  we  do  not  speak  of  "symp- 
toms of  good  health,"  only  symptoms  of  ill  health  or  disease. 
Some  people  always  complain,  some  never.  Some  people  readily 
talk  about  their  ailments,  others  think  it  beneath  their  dignity  to 
complain.  Some  people  when  they  first  come  to  a  new  physician  get 
much  attention  but  in  time  they  may  be  told  their  ills  are  "im- 
aginary," and  then  they  go  elsewhere. 

There  is  an  old  saying  that  chronic  diseases  are  mainly  of  our 
own  making;  it  goes  back  to  the  days  when  the  opposite  was  be- 
lieved of  acute  diseases,  that  these  were  sent  by  Providence  or 
were  unavoidable.  But  since  the  causes  of  many  diseases  and  con- 
ditions of  ill  health  have  been  discovered,  such  sayings  lose  much 
of  their  force.  Many  acute  diseases  and  especially  epidemic  dis- 
eases are  wholly  preventable,  especially  by  a  combined  effort;  the 
individual  alone  may  be  powerless.  We  need  only  think  of  cholera 
and  yellow  fever  and  the  plague.  On  the  other  hand  some  "chronic 
diseases"  are  as  unavoidable  as  they  are  unpreventable ;  they  are 
incident  to  the  human  body,  sooner  or  later  disturbed  functioning 
will  appear,  and  in  the  end  all  must  die. 

Many  chronic  diseases  are  due  to  a  man's  occupation.     Some 

occupations  are  classed  as  dangerous,  tending  to  shorten  a  man's 

life  on  account  of  diseases.     Knife  grinder's  rot  and  phossy  jaw 

are  handy  names.    A  man  may  know  better  than  to  take  up  a  risky 

occupation  and  to  continue  at  it,  but  as  a  matter  of  fact  we  all 

know  that  some  continue  after  being  told  by  the  physician  that  to 

continue  is  to  commit  suicide.     The  poor  man  with  a  family  may 

know  better  but  what  can  he  do  away  from  his  trade?    He  is  apt 

to  work  on  as  long  as  possible.     Plato  long  ago  said: 

"When  a  carpenter  is  ill  ...  .  he  expects  to  receive  a  draught 
from  his  doctor,  that  will  expel  the  disease  hy  vomiting  or  purging,  or 
else  to  get  rid  of  it  by  cauterizing,  or  a  surgical  operation;  but  if  any  one 
were  to  prescribe  to  him  a  long  course  of  diet,  and  to  order  bandages  for 
his  head,  with  other  treatment  to  correspond,  he  would  soon  tell  such  a 
medical  adviser  that  he  had  no  time  to  be  ill,  and  that  it  was  not  worth 
his  while  to  live  in  this  way,  devoting  his  mind  to  his  malady,  and 
neglecting  his  proper  occupation;  and  then  wishing  the  physician  a  good 


262  DUSTY    AIR   AND   ILL    HEALTH. 

morning,  he  would  enter  upon  his  usual  course  of  life  and  either  regain 
his  health  and  live  in  the  performance  of  his  business;  or,  should  his  con- 
stitution prove  unable  to  bear  up,  death  puts  an  end  to  his  troubles."1 

We  also  hear  of  the  rich  man,  perhaps  the  captain  of  industry, 
who  has  been  told  he  is  committing  suicide  by  "working  under 
high  pressure."  Heart  and  kidney  diseases  are  considered  as 
"high  pressure  diseases"  par  excellence.  A  man  may  know  that 
his  occupation,  "making  lots  of  money,"  is  killing  him  but  in 
spite  of  his  physician's  best  advice  he  will  persist.  Some  want  to 
continue  a  year  or  a.  few  years  longer  and  then  retire,  but  they 
die  before  the  time  is  up,  or  they  are  so  worn  out  when  they  do 
retire  that  death  soon  overtakes  them. 

Country  boys  are  constantly  flocking  to  cities.  Some  succeed, 
many  fail.  We  are  apt  to  hear  of  the  successes  but  not  of  the  fail- 
ures. The  boy  who  is  unable  to  "bear  the  pressure,"  to  "stand 
the  racket,"  is  apt  to  return  home  disabled,  perhaps  by  tubercu- 
losis or  some  other  disease  incident  to  the  massing  together  of  hu- 
manity under  conditions  not  conducive  to  health  and  longevity. 
Perhaps  one  in  a  hundred  succeeds  in  bearing  life  in  the  large 
city.  When  the  successful  man  visits  his  old  home  we  hear  much 
about  him,  how  well-fed  and  healthy  he  looks;  his  example  leads 
many  boys  and  young  men  to  try  city  life  also.  The  physician 
knows  that  people  can  not  be  judged  by  their  appearances  and 
that  many  who  seem  in  robust  health  die  suddenly  and  prematurely. 

One  almost  comes  to  the  conclusion  that  poor  people  who  can 
not  "keep  up  pressure"  die  from  tuberculosis  and  similar  wasting 
diseases,  while  rich  people  die  from  heart  and  kidney  diseases. 
Such  a  general  statement  of  course  needs  qualifying  but  it  seems 
true  in  considering  the  past  family  history,  whether  the  ancestry 
is  urban  or  rural  or  to  what  extent  weeding  out  on  account  of 
unsanitary  city  conditions  has  occurred. 

Physicians  have  a  saying  that  a  man  is  as  old  as  his  arteries, 
meaning  the  extent  to  which  his  arteries  have  thickened  or  har- 


1  What  the  workman  should  know  is  that  the  physician  has  no  "cure"  for  many  ills  and  that  there 
is  no  healing  herb  growing  in  the  garden  or  woods.  He  must  learn  that  many  ills  are  of  his  own  making, 
if  they  are  not  due  to  personal  neglect  they  may  be  due  to  the  neglect  of  his  employer  or  of  the  com- 
munity as  a  whole.    Here  we  see  the  advantage  of  Unionism,  in  asking  or  demanding  sanitary  reforms. 


CARDIOVASCULAR   AFFECTIONS.  263 

dened,  either  through  disease  or  from  internal  pressure  on  account 
of  a  strenuous  life  or  on  account  of  living  under  unsanitary  con- 
ditions. Such  a  saying  may  of  course  also  be  applied  to  the  con- 
dition of  a  man's  lungs,  to  what  extent  they  have  been  destroyed 
or  put  out  of  use  on  account  of  clogging  up. 

We  read  of  aged  Indians  and  old  out-of-door  people  having 
arteries  "soft  as  a  child's."  All  physicians  know  that  the  lungs 
of  a  country  man  are  pink  and  those  of  a  resident  of  a  smoky  and 
dirty  city  are  black  as  coal.  The  city  resident  may  early  begin  to 
have  hard  arteries  "to  stand  the  pressure,"  just  as  his  lungs  be- 
come black  on  account  of  the  large  amount  of  carbon  particles 
and  dust  of  all  kind  inhaled.  The  anemic  consumptive  dies  pre- 
maturely, just  as  the  robust  short  necked  apoplectic  man  is  apt  to 
die  prematurely,  if  not  from  apoplexy  then  from  Bright 's  disease. 

At  times  families  show  a  tendency  to  die  from  some  diseases, 
or  group  of  diseases,  there  seems  to  be  some  "hereditary  tend- 
ency." Some  people  expect  to  die  as  their  father  or  mother  died. 
Again,  at  times  people  will  say,  "Why  we  never  had  such  a  dis- 
ease in  the  family,"  as  tuberculosis,  meaning  they  do  not  believe 
they  have  such  a  disease  or  that  they  will  die  from  it,  because 
"It  is  not  in  the  family." 

But  often  the  influence  of  environment  is  greater  than  that  of 
heredity  so-called.  People  may  die  from  tuberculosis,  because  ex- 
posed to  it  as  none  of  their  ancestors  had  been.  Life  in  a  city  is 
radically  different  from  life  in  the  thinly  settled  country,  in  the 
former  the  active  cause  of  consumption  (tubercle  bacilli)  is  all 
about,  in  the  other  it  may  be  wholly  absent. 

In  the  Introductory  I  referred  to  the  influence  of  heredity  and 
of  environment,  telling  of  an  Indian  and  a  white  man  who  applied 
for  life  insurance  and  how  the  white  man  lived  on  and  on  although 
he  had  been  rejected.  The  usual  explanation  is  that  the  Indian  is 
not  accustomed  to  a  life  of  civilization,  to  a  life  under  more  or  less 
pressure.  We  similarly  speak  of  white  people  who  are  not  adapted 
to  the  "high  pressure  of  city  life."  The  Outlook  for  September 
1G,  1911,  says:    "The  death  rate  among  the  Indians  of  the  United 


264  DUSTY    AIR    AND    ILL    HEALTH. 

States  is  two  and  a  half  times  as  great  as  among  the  whites  .  .  ." 
But  we  should  keep  in  mind  that  the  Indian  is  still  living  in  the 
open.    One  wonders  what  his  death  rate  would  be  under  city  life. 

When  we  question  what  is  meant  by  "high  pressure"  we  are 
apt  to  get  all  sorts  of  indefinite  replies  (except  from  those  who 
have  studied  blood  pressure  in  arteries).  The  "strenuous  life," 
the  struggle  for  riches,  the  desire  for  fame,  etc.,  are  expressions 
that  by  many  are  considered  synonymous  with  "high  pressure." 
But  we  may  at  once  ask,  Under  what  conditions? 

What  is  meant  by  high  pressure  life  and  where  is  such  life 
carried  on?  What  distinguishes  the  high  pressure  man  from  the 
low  pressure  man?  We  all  have  some  ideas  on  the  subject.  It  is 
generally  agreed  that  the  high  pressure  man  lives  in  the  large  city 
where  competition  to  make  a  living  and  get  riches  is  keen  or  fierce. 
The  farmer  leading  a  quiet  uneventful  life  is  not  apt  to  be  accused 
of  leading  a  high  pressure  life.  A  man's  surroundings  have  much 
influence. 

The  subject  is  a  vast  one  and  all  sorts  of  replies  may  be  made 
to  the  query  of  what  constitutes  high  pressure  life.  In  a  subse- 
quent volume  I  shall  confine  myself  to  one  phase  of  it — high  pres- 
sure as  shown  in  the  blood  vessels.  This  may  be  measured  by 
proper  instruments,  just  as  the  pressure  of  a  boiler  can  be  meas- 
ured. Perhaps  we  are  justified  in  saying  that  some  men  like  some 
boilers  are  working  under  high  pressure  and  are  in  constant  dan- 
ger of  blowing  up.  Some  blow  up  early.  One  can  go  a  step  further 
and  say  that  men  like  boilers  all  come  to  an  end,  some  rust  out, 
some  blow  up.  Some  blow  up  under  comparatively  low  pressure, 
often  well  rusted. 

High  blood  pressure  effects  as  a  rule  begin  to  show  themselves 
toward  middle  life.  For  one  thing  those  who  tended  to  perish 
from  low  pressure  affections,  notably  tuberculosis,  perished  early. 
The  child  of  high  pressure  parents  is  apt  to  live  through  an  at- 
mosphere that  tends  to  destroy  others  through  tuberculosis,  he  is 
the  survivor  of  the  fittest.  Strong  respiratory  mucous  membranes 
that  can  stand  heavy  city  air  laden  with  soot  and  cinders  and  acids 


CARDIOVASCULAR   AFFECTIONS.  265 

due  to  the  combustion  of  coal  as  well  as  diseases  of  all  kinds;  a 
strong  digestion  able  to  keep  up  HC1;  a  strong  nervous  system 
that  can  work  many  hours  a  day  without  breaking  down ;  similarly 
a  circulatory  system  that  can  keep  up  pressure  and  keep  the  blood 
coursing  through  the  vessels,  all  these  are  necessary  to  reach  at 
least  middle  life  in  the  large  and  dirty  city. 

Nowadays  comparatively  few  die  from  accidents  or  in  wars. 
People  die  in  bed  rather  than  "with  their  boots  on."  In  older 
times  it  was  different  and  in  savage  times  wholly  different. 

A  very  interesting  question  to  the  physician  is  how  do  city 
people  with  a  long-lived  country  ancestry  end?  Are  they  likely 
to  live  long? 

Why  do  some  families  tend  to  die  from  diseases  attended  by 
low  blood  pressure,  others  by  a  high  blood  pressure  ?  At  what  age 
do  members  of  such  families  fail?  The  death  of  a  small  child  or 
of  an  old  man  or  woman  may  mean  little  to  a  community.  The 
death  of  a  middle-aged  man  with  a  large  family  of  children  may 
mean  much.  To  what  extent  is  the  community  responsible  for  the 
death  of  the  head  of  a  family  and  responsible  for  the  care  of  his 
children  ?  These  and  similar  questions  are  receiving  more  and  more 
attention. 

I  have  referred  to  this  subject  very  briefly  because  I  intend  to 
take  it  up  in  detail  later.  Here  I  merely  wish  to  bring  out  the 
point  that  a  dust  victim  may  be  apparently  very  robust,  that  he 
may  not  at  all  fail  through  tuberculosis  or  catarrhal  pneumonia 
or  through  loss  of  strength,  but  that  car dio -vascular  failure  may 
come  on  suddenly. 

In  the  original  outline  for  this  volume  it  was  planned  at  this 
place  to  cite  a  number  of  illustrative  cardio-vascular  case  reports, 
beginning  with  early  ones  that  were  misunderstood,  just  as  dys- 
peptics and  neurasthenics  had  been  misunderstood.  But  case  re- 
ports are  of  such  variety  and  there  are  so  many  little  things  that 
should  be  mentioned  that  I  finally  came  to  the  conclusion  to  devote 
a  separate  volume  to  them,  especially  since  the  subject  of  health 


266  DUSTY    AIR    AND    ILL    HEALTH. 

supervision  must  be  considered  in  some  detail.  Here  I  shall  men- 
tion only  one  eardio-vascular  case  on  account  of  the  discussion  of 
symptoms,  that  symptoms  may  be  considered  as  warnings  to  be 
heeded,  perhaps  as  blessings  in  disguise. 

Mrs.  — .  Middle-aged  well-to-do  housewife.  (We  have  not  yet 
reached  a  stage  where  we  can  mention  a  patient's,  or  the  family's, 
income  to  enable  the  reader  to  get  some  idea  of  an  individual's 
ability  to  fully  live  up  to  medical  advice — in  the  light  of  this  vol- 
ume, to  good  air  advice,  with  all  that  that  implies.)  She  came  to 
me  complaining  of  a  train  of  symptoms,  especially  nervous  symp- 
toms, that  at  once  directed  my  attention  to  the  possibility  of  cardio- 
vascular disturbances.  I  found  a  high  blood  pressure,  as  expected. 
I  soon  came  to  the  conclusion  she  was  a  dust  victim  and  that  the 
high  pressure  was  dependent  on  exposure  to  bad  air.  At  the  very 
first  interview  I  told  her  of  my  observations  on  similar  cases;  by 
watching  air  conditions  she  likely  could  verify  my  ideas.  She  was 
willing  to  observe  and  keep  a  record.  In  the  course  of  a  few 
months  the  idea  that  her  high  blood  pressure  was  due  to  dust  in- 
fluences was  fully  verified. 

This  patient  reported  at  first  weekly,  then  bi-weekly,  and  finally 
once  a  month.  During  these  consultations  a  number  of  topics  were 
discussed,  and  because  she  was  philosophical,  some  topics  were 
taken  up  that  are  ordinarily  not  considered  at  all. 

With  such  a  patient  one  can  consider  health  supervision  in 
detail,  how  much  or  how  little  is  to  be  expected  from  it.  One  can 
discuss  details  that  one  would  scarcely  think  of  taking  up  with 
the  individual  whose  whole  life  is  a  constant  struggle  for  existence 
and  to  whom  sickness  and  inability  to  work  spell  disaster. 

Here  and  there  in  this  volume  I  referred  to  discussions  I  had 
with  patients  in  whom  there  was  no  marked  organic  change,  who 
under  good  air  conditions  would  likely  go  on  for  years.  But  there 
is  another  class  of  patients,  cardio- vascular  cases,  the  kind  just 
mentioned,  in  whom  on  account  of  high  blood  pressure  there  may 
be  a  more  or  less  marked  change,  especially  a  thickening  of  the 
blood  vessels  to  resist  pressure.    How  long  such  an  individual  will 


CARDIO-VASCULAK    AFFECTIONS.  267 

last  is  a  problem.  It  may  be  a  matter  of  a  short  time  only,  but 
with  prudence  he  may  last  for  years  even  though  one  feels  that 
the  span  of  life  is  very  uncertain.  To  what  extent  shall  conditions 
be  freely  discussed  with  an  individual  of  this  kind?  Here  we  must 
at  once  distinguish  between  those  who  are  philosophical,  who  look 
things  squarely  in  the  face,  and  the  opposite,  those  who  if  they 
knew  the  real  condition  of  affairs  would  "fly  to  pieces."  (Shall 
we  speak  of  a  third  group,  the  religious,  who  believe  they  are  in 
God's  hands  and  take  no  care  of  the  morrow?  Some  of  them  call 
on  the  physician  at  the  eleventh  hour  when  little  or  nothing  can 
be  done.  Shall  we  add  that  the  world  is  advancing  and  that  even 
the  fatalistic  Turk  is  outgrowing  old  time  beliefs?) 

As  a  general  statement  it  may  be  said  that  the  intellectual  and 
those  in  easy  circumstances  who  need  not  worry  on  account  of  finan- 
cial conditions  belong  to  the  former  class,  while  the  ignorant  and 
those  in  straitened  circumstances  as  a  rule  belong  to  the  latter 
— people  not  apt  to  read  this  volume. 

In  order  to  teach  the  average  patient  the  physician  must  appeal 
to  his  intelligence  and  past  experiences  and  use  suitable  illustra- 
tions. Some  learn  with  difficulty,  some  are  apparently  unteachable. 
On  the  other  hand  is  the  exceptional  individual,  shall  we  say  he 
belongs  to  the  class  who  are  readers?  (Out  of  the  many  local  li- 
brary users  the  vast  majority  are  only  novel  readers).  He  is  the 
individual  with  whom  one  can  discuss  things  frankly,  things  that 
one  does  not  discuss  with  the  average  individual  who  comes  to  the 
doctor's  shop.  It  is  necessary  to  refer  to  this  matter  in  order  that 
the  remaining  portion  of  this  volume  will  be  properly  understood. 
Often  one  hesitates  to  speak  freely  about  some  topics  for  fear  of 
being  misunderstood.  Needless  to  say  in  making  verbal  explana- 
tions one  always  feels  his  way,  statements  can  be  immediately  mod- 
ified, objections  answered  and  adverse  criticism  that  one  gets  by 
rushing  into  print  avoided. 

The  following  topics  have  been  discussed  with  comparatively 
few  patients  and  that  means  opinions  are  subject  to  revision  and 
correction,  many  are  topics  upon  which  opinions  differ  widely. 


268  DUSTY    AIR   AND    ILL    HEALTH. 

Living  in  Isolation.  The  above  patient  had  learned  in  the 
course  of  time  that  she  had  least  ill  health,  or  disagreeable  symp- 
toms, by  living  in  isolation,  by  rarely  going  into  crowds.  Because 
she  rarely  went  into  crowds,  she  was  regarded  as  peculiar,  a  fact 
which  she  realized  but  said  she  did  not  care.  She  looked  the  pic- 
ture of  health ;  when  she  did  attempt  to  explain  her  condition  and 
ill  health  she  was  not  understood.  She  preferred  to  live  in  isola- 
tion and  be  misunderstood  rather  than  go  out  and  make  misunder- 
stood explanations.  Not  knowing  where  the  real  danger  lay  she 
went  to  extremes  and  yet  in  spite  of  being  "exceedingly  careful" 
she  had  more  or  less  ill  health.  After  her  attention  was  directed 
to  the  dust  factor  she  knew  how  to  guard  herself  properly  and  at 
the  same  time  she  realized  that  there  was  less  need  of  isolation, 
her  only  requirement  to  have  good  health  is  good  air. 

She  is  literary,  fond  of  reading  and  discussing  literature,  but 
opportunities  to  take  part  in  discussions  are  limited.  I  have  re- 
peatedly met  individuals  of  this  kind  and  several  times  I  have 
advocated  the  formation  of  a  "High  Pressure  Club,"  that  is,  for 
people  of  kindred  ailments  and  kindred  minds  to  meet  now  and 
then,  under  suitable  air  conditions,  of  course,  to  discuss  topics  of 
mutual  interest.  But  there  are  too  few  in  a  small  community 
whose  minds  are  really  kindred  and  so  nothing  came  of  the  project. 

Patients  of  this  kind  as  a  rule  are  interested  in  reading  the 
biographies  of  literary  people  who  had  chronic  ill  health.  They 
readily  understand  the  air  factor,  likewise  why  such  individuals 
may  have  needed  the  contact  of  kindred  minds,  perhaps  only  to 
be  found  in  large  cities,  while  health  conditions  demanded  retire- 
ment to  the  pure  air  of  the  country,  as  in  the  case  of  the  Carlyles, 
who  mentally  required  city  life  but  physically  country  air.  Sam- 
uel Johnson  says : 

"There  is  indeed  no  need  of  research  and  refinement  to  dis- 
cover that  men  must  generally  select  their  companions  from  their 
own  state  of  life,  since  there  are  not  many  minds  furnished  for 
great  variety  of  conversation,  or  adapted  to  multiplicity  of  intel- 
lectual entertainments." 


CARDIOVASCULAR   AFFECTIONS.  269 

To  What  Extent  Shall  One  Advise  a  Life  of  Seclusion? 
Every  physician  knows  that  patients  if  put  on  a  certain  track  often 
go  to  extremes,  something  which  one  may  greatly  regret.  The  indi- 
vidual who  has  a  tendency  to  lead  a  secluded  life  may  become 
practically  a  hermit.  On  the  other  hand,  to  advise  a  life  of  more 
or  less  seclusion  to  one  who  is  fond  of  society  may  mean  the  prompt 
termination  of  the  relationship  of  physician  and  patient.  For  in- 
stance, a  middle-aged  woman,  very  fond  of  society,  came  to  me  com- 
plaining greatly.  I  concluded  she  was  a  dust  victim  with  a  high 
blood  pressure.  There  may  also  have  been  kidney  disturbance  but 
she  objected  to  any  examination  to  give  certainty.  She  wanted  to 
know  if  I  could  not  simply  give  her  some  medicine  or  some  good 
advice.  I  promptly  advised  her  along  the  line  of  pure  air  require- 
ments. "When  she  fully  understood  what  this  meant,  to  go  out  less 
into  society  and  into  crowds  of  all  kinds,  she  suddenly  exclaimed, 
"Don't  you  have  any  social  aspirations  yourself  to  realize  what 
your  advice  to  me  means?"  What  shall  one  say  in  reply?  This 
woman  was  mentally  the  opposite  from  the  one  just  mentioned; 
a  free  discussion  was  entirely  out  of  the  question.  I  merely  said 
that  a  physician  could  simply  advise;  the  patient  would  have  to 
decide  whether  to  follow  the  advice  or  not.  Had  she  been  a  relative 
or  a  good  friend,  I  should  have  insisted  that  my  advice  be  followed. 
When  she  found  I  had  no  curative  medicine  and  that  in  order  to 
feel  better  she  would  have  to  cut  down  on  social  affairs,  she  did 
not  become  my  patient  at  all. 

Going  to  Church  or  Not.  If  a  physician  is  satisfied  that  going 
to  church  has  a  bad  influence  on  states  of  health,  should  he  advise 
the  patient  to  remain  away? 

Now  we  all  know  that  a  certain  class  of  individuals  place  re- 
ligion above  everything;  some  who  are  born  into  a  certain  religion 
think  they  can  not  get  along  without  it,  and  if  the  physician  were 
to  tell  them  not  to  go  to  church  they  likely  would  promptly  change 
doctors.  This  is  especially  sad  in  the  case  of  old  people  who  be- 
lieve they  must  go  down  town  to  church  almost  every  day  and  on 


270  DUSTY   AIR   AND   ILL   HEALTH. 

this  account  are  in  constant  ill  health  and  misery.    There  are  Very 
few  individuals  with  whom  one  can  discuss  this  question  freely. 

It  should  be  kept  in  mind  that  in  a  small  community  all  sorts 
of  people  meet  in  the  same  church.  The  very  cleanly  and  those 
the  opposite  come  together.  Those  coming  from  clean  suburbs  and 
those  from  what  amount  to  slum  districts  meet.  One  can  point  out 
these  tilings  and  how  in  large  cities  churches  will  be  found  in  the 
clean  suburbs,  attended  only  by  cleanly  people,  where  air  condi- 
tions are  unobjectionable.  If  a  patient  is  very  religious  one  can 
advise  a  removal  to  a  community  where  churches  are  kept  clean 
and  well  ventilated,  and  where  the  importance  of  sanitation  is  un- 
derstood. Here  is  a  pertinent  clipping  from  the  Western  Christian 
Advocate  of  May  12,  1909 : 

"THE    DOORKEEPER    IN    THE    HOUSE   OF   THE   LORD. 

"Some  one,  somewhere,  some  time  ought  to  establish  a  college  of  jan- 
itors. The  ignorance  of  the  average  janitor  as  to  problems  of  sanitation 
in  public  buildings,  the  regulation  of  beat,  and  particularly  of  proper 
ventilation,  is  immeasurable.  Church  trustees  generally  hire  the  lowest 
bidder  to  take  care  of  the  church,  open  and  close  the  doors,  sweep  and 
dust,  and  make  the  fires.  The  functionary  is  ignorant  of  the  most  ele- 
mentary principles  regarding  fresh  air,  and  in  fact  seems  to  have  an  an- 
tipatby  to  it;  it  hinders  getting  the  auditorium  quickly  heated.  It  never 
occurs  to  him  to  effect  a  change  of  atmosphere  after  one  congregation  bas 
used  up  all  the  ozone.  Not  infrequently  ancient  things  in  the  basement 
send  up  through  the  registers  hot  air  charged  with  staleness  and  musti- 
ness.  If  the  wind  blows  through  the  church-rooms  once  a  week  it  is  a 
liberal  allowance. 

Frequently  a  congregation  breathing  devitalized  air,  even  when  most 
interested,  shows  signs  of  drowsiness  and  stupidity  after  the  first  quarter 
of  an  hour.  It  affects  the  preacher,  too,  who  feels  that  he's  speaking  in 
a  kind  of  vacuum.  His  lungs  are  soon  exhausted  of  their  vitality.  It's 
an  immense  pity  that  so  often  the  whole  service  of  worship — the  comfort 
and  profit  of  the  people — the  sermon  upon  which  much  care  and  labor  has 
been  expended — should  be  utterly  spoiled  by  the  stupidity  of  some  in- 
competent janitor  who  gets  the  church  too  hot  or  too  cold,  too  stuffy  or 
too  draughty.  Architects  should  pay  more  attention  to  the  beating  and 
ventilation  of  churches  of  even  small  cost,  and  church  trustees  ought  to 
pay  enough  for  the  services  to  "the  sexton"  to  secure  men  of  some  knowl- 
edge, experience,  and  judgment." 


CARDIOVASCULAR    AFFECTIONS.  271 

Such  a  "fresh  air"  article  should  direct  the  attention  of  church 
people  to  the  importance  of  selecting  good  janitors. 

From  general  remarks  I  might  briefly  refer  to  a  specific  case: 
One  day  as  I  passed  one  of  our  large  new  churches  on  the  street 
car,  the  colored  janitor  was  standing  in  the  doorway,  arms  akimbo, 
and  just  then  spat  a  large  mouthful  of  tobacco  juice  on  the  fiber 
doormat  before  him.  (In  the  nearby  High  School  I  have  seen  the 
janitor  spit  into  the  hot  air  register — and  I  am  told  that  at  least 
one  of  the  teachers  did  the  same.)  Is  it  necessary  to  say  that  no 
clean  community  would  for  a  moment  tolerate  such  conditions  and 
that  an  enlightened  congregation  would  be  very  careful  in  selecting 
a  janitor?  Negroes  in  whom  the  weeding  out  process  has  been 
going  on  only  a  short  time  and  who  have  a  high  death  rate  from 
tuberculosis  are  least  desirable  as  janitors. 

Advising  a  Patient  to  Move.  Cities  vary  greatly  in  cleanli- 
ness and  especially  in  respect  to  the  spitting  habit.  Some  of  my 
patients  who  complain  greatly  here  do  very  well  under  a  different 
environment.  Shall  a  physician  advise  them  to  move?  Those  an- 
swering from  a  selfish  standpoint  will  likely  say  No,  for  constantly 
to  send  away  good  patients  leaves  one  with  a  lot  of  poor  ones  un- 
able to  get  away.  But  when  one  considers  the  patient's  welfare, 
puts  oneself  in  his  place,  the  matter  assumes  a  different  aspect. 

As  already  mentioned,  our  streets  are  either  covered  with  dust 
or  mud  and  the  down  town  sidewalks  with  spittle  and  floors  of 
public  buildings  are  not  clean.  It  is  difficult,  almost  impossible, 
to  escape  dust  infection.  Practically  the  only  solution  is  to  remove 
to  a  clean  community.  There  are  few  unbiased  individuals  with 
whom  one  can  freely  discuss  this  question  of  moving,  of  leaving 
one's  home  town  and  friends.  The  physician  who  speaks  frankly 
is  likely  to  acquire  the  reputation  of  being  opposed  to  a  community, 
of  being  a  "knocker." 

Keeping  a  Daily  Record  I  have  already  referred  to  this  in 
the  case  of  ordinary  patients.     The  question  assumes  a  somewhat 


212  DUSTY    AIR    AND    ILL    HEALTH. 

different  aspect  with  the  educated,  those  who  lead  a  mental  life  in 
addition  to  merely  vegetating.  In  the  one  class  a  diary  or  a  record 
may  be  very  simple,  in  the  other  it  may  be  complex.  Some  people, 
patients,  are  afflicted  with  insomnia ;  they  lie  awake  at  nights  think- 
ing all  sorts  of  thoughts.  Should  there  be  a  mention  of  these 
thoughts  in  a  daily  record,  should  patients  be  told  to  make  an 
attempt  to  find  out  why  certain  thoughts  come  up? 

At  times  the  patient  here  under  discussion  would  have  a  train 
of  thoughts  and  an  almost  irresistible  impulse  to  get  up  and  write 
them  out  Her  previous  physicians  had  told  her  to  resist,  not  to 
get  up,  that  it  would  only  aggravate  her  insomnia.  I  advised  the 
opposite  course,  both  because  the  thoughts  or  ideas  might  be  val- 
uable and  if  not  written  down  the  remembrance  might  be  wholly 
lost  the  next  morning,  and  because  the  mind  would  perhaps  be  at 
ease  after  these  insistent  thoughts  were  written  down.  I  advised 
that  when  there  was  an  active  train  of  thought  either  to  get  up  or 
to  write  in  bed,  telling  of  my  own  experience  in  having  accustomed 
myself  to  writing  in  the  dark.  My  observations  lead  me  to  con- 
clude that  when  this  is  done  sleep  usually  follows.  It  seems  some 
individuals  will  lie  awake  at  night  with  a  train  of  thoughts  con- 
stantly going  through  the  mind,  while  the  moment  these  thoughts 
are  put  down  on  paper  the  mind  is  at  rest  and  sleep  returns.  The 
number  of  patients  with  whom  one  can  discuss  such  a  "Seelen- 
leben"  is  very  limited  indeed. 

Mental  Influences.  Neglecting  Symptoms.  Individuals 
vary  greatly  in  regard  to  imagining  things.  Some  with  active 
minds  are  constantly  thinking  about  things,  even  dream  about 
them,  while  others  apparently  do  not  think  or  dream  at  all.  The 
appearance  of  certain  symptoms  may  cause  a  good  deal  of  worry, 
merely  by  imagining  all  sorts  of  things.  We  dread  what  we  do 
not  understand.  I  have  already  referred  to  a  patient  lying  awake 
at  night.  Shall  we  advise  neglecting  symptoms  or  shall  we  tell 
the  patient  to  attempt  to  determine  under  what  conditions  this 
active  thinking  or  active  imagining  occurs?  But  even  the  most 
active  minded  individuals  have  times  when  they  feel  dull  and  think- 


CARDIO-VASCULAR  AFFECTIONS,  273 

ing  is  an  effort.    Perhaps  here  too  one  may  make  an  effort  to  find 
the  reason. 

Euthanasia.  In  the  family  history  of  this  patient  "gradual 
death"  has  been  the  rule,  that  is,  there  has  been  much  lingering 
sickness  and  much  suffering  before  death  finally  occurred.  One 
day  she  told  me  she  dreaded  dying  that  way,  she  would  prefer  to 
die  suddenly.  This  naturally  led  to  a  discussion  of  the  usual  fate 
of  a  high  pressure  victim  by  apoplexy,  although  there  may  be 
repeated  apoplexies  and  much  paralytic  disturbance  before  there 
is  a  "stroke"  sufficiently  severe  to  kill.  Early  strokes  may  simply 
disable,  perhaps  be  followed  by  much  misery,  while  those  coming 
in  later  years  are  apt  to  kill  quickly.  If  the  individual  can  live 
in  a  manner  to  keep  off  early  strokes  there  will  likely  be  euthan- 
asia, in  fact  he  may  die  of  some  other  affection  than  the  familial 
one. 

This  is  not  a  pleasant  subject  to  discuss,  yet  if  an  individual 
wants  discussion  to  get  light,  to  whom  will  she  likely  apply?  To 
whom  if  not  a  physician  ? 

This  subject  naturally  led  to  a  discussion  of  views  among  phy- 
sicians regarding  euthanasia,  a  topic  that  is  ordinarily  tabooed. 
We  both  came  to  the  conclusion  that  a  physician  should  be  careful 
how  he  talks  about  this  subject,  that  a  physician's  function  relates 
to  the  prolonging  of  life  and  palliating  suffering  in  the  incurable. 

But  not  all  want  a  sudden  and  painless  death;  the  religion  of 
some  is  opposed  to  this  idea  of  sudden  death,  some  pray  against 
sudden  death,  they  want  time  for  extreme  unction.  On  the  other 
hand  a  preacher  told  me,  "Be  prepared  to  die  at  any  time." 

Herbert  Spencer  while  doing  newspaper  work  in  the  heart  of 

London  and  putting  in  his  spare  time  on  his  first  book,  relates  in 

his  autobiography: 

"The  offspring  of  the  mind,  like  the  offspring  of  the  body,  are  apt  to 
become  objects  of  engrossing  interest  to  which  all  other  objects  are  sub- 
ordinated. A  striking  illustration  of  this  was  furnished  by  me  early  in 
1849,  as  I  was  taking  my  morning  walk  in  St.  James's  Park.  The  weather 
was  frosty;  and,  having  a  bad  cold,  I  was  coughing  violently.  Abrasion 
of  a  small  superficial   bloodvessel  produced  some   appearances   which  I, 

(18) 


274  DUSTY    AIR    AND    ILL   HEALTH. 

little  the  better  it  seems  for  such  medical  knowledge  as  I  possessed,  ab- 
surdly Interpreted  into  spitting  of  blood,  and  at  once  inferred  tbat  I  was 
doomed.  As  I  walked  on  in  saddened  mood,  my  first  thought  was — "It  will 
be  a  pity  if  I  can't  finisb  my  book  first."    p.  406,  Vol.  I. 

Herbert  Spencer  soon  realized  that  bad  air  did  not  agree  with 
him  and  he  moved  to  the  clean  suburbs  and  spent  much  time  in 
the  open — and  in  the  end  died  of  "old  age,"  aged  eighty-three 
years. 

Discussion  of  Symptoms.  Symptoms  have  been  briefly  dis- 
cussed in  Chapter  V.  But  there  is  another  side  to  the  question, 
one  that  can  be  discussed  with  only  a.  few,  with  the  philosophical. 
This  is  the  beneficence  of  symptoms.  Ordinarily  it  is  assumed  that 
symptoms  (and  indeed  ill  health  and  disease)  are  great  evils,  but 
arguments  can  be  advanced  in  opposition,  that  symptoms  are  bless- 
ings in  disguise. 

It  should  be  kept  in  mind  that  in  cardio-vascular  cases  one  can 
make  rather  sharp  distinctions  between  subjective  and  objective 
symptoms,  those  which  the  patient  experiences  and  which  the  phy- 
sician must  take  on  faith,  and  those  symptoms  or  signs  that  may 
not  be  recognizable  by  the  patient  himself,  at  least  seldom  are,  but 
which  can  readily  be  determined  by  the  physician.  For  instance, 
all  statements  referring  to  pain  have  to  be  taken  by  the  physician 
for  what  they  are  worth,  he  has  no  instrument  to  determine  the 
presence  of  pain  or  to  estimate  its  intensity.  On  the  other  hand 
variations  in  blood  pressure,  variations  in  the  action  of  the  heart, 
variations  of  urinary  constituents  and  the  appearance  of  abnormal 
substances  may  be  wholly  unknown  to  the  patient  and  unrecog- 
nizable by  him.  Ordinarily  a  physician  does  not  go  into  details 
regarding  objective  symptoms,  or  "laboratory  findings,"  because 
few  patients  understand  them,  but  he  may  to  good  advantage  dis- 
cuss subjective  symptoms,  and,  in  the  case  of  the  philosophical, 
show  that  the  popular  conception  is  not  a  good  one,  that  as  a  rule 
symptoms  are  blessings  in  disguise;  that  they  are  warnings  from 
nature  to  be  heeded.  The  subject  is  a  vast  one;  one  can  not  do  it 
justice  in  a  brief  discussion. 


CARDIOVASCULAR   AFFECTIONS.  275 

Symptoms  of  III  Health.  Symptoms  of  Disease.  It  may  be 
said  that  diseases  are  due  to  definite  pathogenic  or  disease-pro- 
ducing causes,  and  on  the  other  hand  that  common  ill  health  is 
usually  due  to  an  abnormal  environment,  or  to  variable  causes. 
Nature  tells  us  through  symptoms  that  something  is  wrong;  by 
heeding  the  warnings  and  avoiding  abnormal  conditions  symptoms 
will  likely  subside. 

Language  and  letters  enable  us  to  express  our  ideas  to  others, 
both  must  be  learned.  Some  ideas  can  be  expressed  by  the  illiter- 
ate, we  need  only  think  of  the  cry  of  a  small  child.  But  what  a 
vast  difference  between  the  illiterate  man  and  the  educated  chronic 
in  telling  about  symptoms! 

People  vary  greatly.  On  the  one  hand  we  find  people  who  "go 
all  to  pieces"  on  the  appearance  of  ill  health  and  disease;  on  the 
other  hand  are  those  who  are  philosophical  and  remain  calm.  Time 
of  course  makes  great  changes,  and  the  at  first  impatient  may  be- 
come patient  and  philosophical.  The  man  sick  for  the  first  time 
wants  to  be  cured  at  once;  the  old  chronic  merely  asks  for  relief, 
to  reduce  symptoms  to  a  minimum. 

"With  some  individuals  there  is  no  discussing  symptoms,  all 
they  want  is  medicine  that  will  cure.  With  some  a  physician  must 
almost  speak  of  symptoms  as  entities,  as  something  to  be  "driven 
out,"  perhaps  by  a  very  disagreeable  smelling  or  tasting  medicine. 
To  the  few  one  can  point  out  that  many  symptoms  are  due  to  an 
unsanitary  environment  (in  dust  victims)  and  that  removal  from 
the  cause  may  be  all  that  is  necessary  for  symptoms  to  disappear. 
With  an  exceptional  patient,  the  philosophical,  as  just  mentioned, 
one  can  even  discuss  symptoms  as  beneficent  processes,  sent  by  Na- 
ture to  warn  us,  or  to  enable  her  to  repair  damages. 

With  that  rare  individual  who  has  some  knowledge  of  Evolu- 
tion the  subject  can  be  discussed  from  an  evolutionary  standpoint, 
of  the  survival  of  the  fittest,  and  how  Nature  has  weeded  out  those 
who  do  not  heed  warnings,  and  how  the  process  is  still  going  on 
today. 


276  DUSTY    ATR    AND    ILL    HEALTH. 

SYMPTOMS  OF  ILL  HEALTH  AS  WARNINGS  FROM 

NATURE. 

In  enumerating  symptoms  it  is  always  a  question  how  they 
should  be  given,  in  alphabetical  order  or  in  the  order  of  their  im- 
portance, and  whether  common  or  technical  names  should  be  used. 

Anorexia.  This  is  the  technical  term  for  loss  of  appetite,  and 
whether  this  term  is  used  or  "Appetite,  loss  of,"  it  would  still 
head  the  list  in  alphabetical  order,  as  it  would  also  according  to 
its  importance,  coming  only  after  Pain. 

Loss  of  appetite  is  very  common,  both  in  ill  health  and  in  dis- 
ease. AVhen  a  man  is  sick  Nature  takes  away  his  appetite,  and 
that  means  the  stomach  is  getting  a  rest  and  the  patient  has  to 
rest;  and  in  the  mean  time  Nature  is  repairing  the  damage,  or 
fighting  off  the  disease.  The  worst  form  of  treatment  is  to  insist 
on  the  invalid  eating.  (I  am  of  course  not  speaking  of  the  excep- 
tional case  where  feeding  may  be  required.) 

At  times  we  hear  individuals  say  after  an  attack  of  typhoid 
fever,  "after  that  I  never  felt  better  in  my  life."  This  means  for 
one  thing  that  he  had  been  resting  and  fasting.  Dr.  Tanner  fasted 
forty  days,  and  so  we  need  not  fear  starvation  from  a  few  days' 
fast. 

Asthenia,  which  literally  means  lacking  strength,  is  due  to  a 
great  variety  of  causes.  It  may  be  due  to  anemia,  a  deficiency  of 
blood,  either  in  quantity  or  in  quality.  If  much  blood  is  lost  from 
a  wound  or  an  injury  we  all  know  that  by  keeping  quiet  in  time 
nature  replaces  the  loss.  If  loss  of  strength  as  well  as  anemia  is 
due  to  lack  of  food,  proper  food  will  restore  normal  conditions. 
Bad  air  may  occasion  an  anemia  that  produces  a  great  loss  of 
strength.  In  fact  the  individual  may  get  so  weak  that  he  must 
remain  at  home.  There  are  all  sorts  of  tonics  but  the  best  one  after 
all  is  exercise  in  the  open  air.  and  in  proportion  as  an  individual 
does  stay  away  from  bad  air  conditions  he  gets  better.  The  man 
who  is  wise  will  stajr  away  entirely,  or  he  will  change  his  occupa- 
tion  or  remove  from   an  unsanitary   environment.     Many  in  ill 


CARDIO- VASCULAR  AFFECTIONS.  277 

health  must  get  worse  before  they  get  better,  before  heeding  Na- 
ture's warnings. 

Breath,  Getting  out  of  (Dyspnea).  This  is  a  very  common 
symptom,  especially  among  those  not  accustomed  to  exercise.  When 
they  do  exercise  beyond  the  extent  to  which  they  are  accustomed 
the  body  rebels,  Nature  takes  away  the  breath  and  the  individual 
must  desist.  It  is  a  wise  provision  of  Nature,  otherwise  a  weak 
heart  might  quickly  go  to  pieces.  But  many  individuals  who  are 
weak  need  exercise.  They  should  start  in  gradually  and  the  whole 
body,  including  the  heart,  will  react  and  get  strong,  and  then  they 
are  able  to  do  considerable  exercising  without  getting  out  of  breath. 

If  the  individual  who  is  short  of  breath  persists  in  exertion  he 
is  likely  to  faint  and  that  will  make  him.  desist.  Shall  we  say  that 
that  is  an  additional  way  Nature  has  of  enforcing  her  warnings? 

Cough.  This  has  already  been  sufficiently  referred  to  under 
Colds  and  Catarrh,  as  being  a  provision  of  Nature  to  bring  up  for- 
eign substances,  especially  dust.  If  a  certain  cause  brings  on  cough, 
the  proper  treatment  is  to  avoid  that  cause  and  not  to  use  a  cough 
cure,  which  may  simply  numb  the  nerves  of  sensibility  and  thereby 
aggravate  in  the  end. 

Chilling.  Chilling  is  due  to  various  causes,  as  previously  men- 
tioned. In  cold  weather  it  is  a  warning  to  keep  out  of  the  cold, 
or  to  dress  warmer.  To  chill  after  a  cold  bath  means  to  avoid 
cold  baths.  To  chill  after  exposure  to  bad  air  means  to  avoid  the 
cause. 

Constipation.  It  may  seem  odd  to  mention  constipation  in 
connection  with  conservative  or  beneficent  processes,  and  yet  it  has 
been  claimed  that  a  less  amount  of  fluid  makes  the  feces  less  a 
culture  medium  for  injurious  bacteria,  that  it  is  a  provision  of 
nature  to  help  the  body.  Be  that  as  it  may,  I  find  over  and  over 
in  dust  victims  that  constipation  is  to  be  regarded  simply  as  a 
warning  and  if  the  warning  is  heeded  and  the  environment  is 
changed,  the  constipation  subsides  naturally. 


278  DUSTY   AIR   AND   ILL    HEALTH. 

Emaciation.  This  may  be  dependent  on  a  great  variety  of 
causes.  Loss  of  flesh  goes  hand  in  hand  with  illness,  and  that  means 
to  rest,  and  often  when  an  individual  rests  Nature  is  given  a  chance 
to  correct  the  difficulty  on  which  emaciation  depends.  If  emacia- 
tion is  dependent  on  food,  as  among  the  poor,  the  proper  remedy 
is  an  abundance  of  nutritive  food,  not  a  little  medicine,  which  often 
simply  benumbs  sensibility.  If  loss  in  weight  is  dependent  on  con- 
tinued infection,  with  the  body  at  a  disadvantage,  the  proper  rem- 
edy is  to  get  awaj7-  from  the  source  of  infection.  If  it  is  dependent 
on  bad  air  the  remedy  is  clear.  If  emaciation  is  dependent  on  the 
presence  of  pernicious  disease,  then  the  Lord  help  you — you  are 
past  the  aid  of  man.  We  should  try  to  avoid  pernicious  diseases 
in  time.    Much  is  preventable. 

Fatigue.  Fatigue  spells  rest  from  work,  from  whatever  pro- 
duces the  feeling  of  fatigue  or  of  being  tired  out.  A  man  who  is 
fatigued  from  hard  manual  labor  requires  rest;  that  is  a  truism 
recognized  by  everybody.  A  society  woman  who  is  "overworked" 
may  also  require  rest.  To  the  latter  many  things  are  a  real  task 
that  to  others  may  be  a  pleasure,  as  making  calls  or  going  to  par- 
ties; the  poor  who  make  these  at  long  intervals  enjoy  them,  while 
one  who  does  this  constantly  may  find  it  a  burden.  Fatigue  may 
go  to  the  point  of  loss  of  ambition,  that  is  a  warning  that  many 
heed,  and  then  Nature  is  apt  to  restore  the  balance.  It  would  seem 
some  cases  of  fatigue,1  so-called  nervous  prostration,  are  simply 
cases  in  which  the  defences  of  the  body  against  infection  are  over- 
worked, merely  getting  into  good  air  causes  the  symptoms  to  sub- 
side. 

Fever.  This  may  be  said  to  be  Nature 's  way  of  telling  us  what 
is  going  on  during  infection.  Its  height  can  be  measured  by  the 
thermometer.  Fever  may  really  be  a  conservative  process  and  phy- 
sicians are  careful  how  depressants  are  given,  drugs  that  "break 
the  fever."  A  mild  fever  may  not  be  heeded  by  an  individual, 
but  when  it  is  high  he  will  likelv  decide  to  take  to  his  bed.     Rest 


1 1  am  here  not  making  fine  distinctions  between  termi. 


CARDIO-VASCULAR    AFFECTIONS.  279 

in  bed  is  one  of  the  best  medicines,  but  unfortunately  many  are 
opposed  to  it,  or  were  so  in  former  days  when  the  sick  room  was 
closed  up  tightly  and  darkened,  wholly  unlike  the  modern  sick 
room  in  a  hospital. 

Hyperacidity  of  the  Stomach.  This  may  be  simply  a  pro- 
vision of  Nature  to  fight  off  infection ;  if  it  disappears  in  good  air 
the  remedy  to  a  sensible  man  should  be  clear — get  out.  It  may  be 
added  that  the  causes  of  hyperacidity  as  of  high  blood  pressure  are 
poorly  understood  and  there  are  all  sorts  of  theories  and  endless 
discussion. 

High  Blood  Pressure.  Is  this  too  to  be  regarded  as  a  con- 
servative process?  Does  it  help  the  individual  for  a  time?  Often 
it  goes  to  extremes  and  ends  fatally.  If  a  high  pressure  subsides 
by  a  change  in  environment,  should  the  physician  discuss  the  sub- 
ject fully  with  his  patient  and  advise  him  to  make  a  change?  (This 
was  done  in  the  case  of  the  present  patient — by  living  up  to  the 
pure  air  requirements  her  high  pressure  with  a  train  of  symptoms 
promptly  subsided.) 

Insomnia.  There  are  many  causes  that  produce  sleeplessness, 
many  of  them  dependent  on  environment.  The  countryman  is  un- 
able to  sleep  near  a  boiler  shop ;  the  city  man  is  kept  awake  by  the 
crowing  rooster.  The  natural  time  to  sleep  is  at  night  when  things 
are  quiet,  and  for  countless  ages  man  has  slept  under  such  condi- 
tions; those  who  "turn  night  into  day"  are  reversing  the  order  of 
Nature.  If  a  man  persists  with  night  work  after  being  warned  that 
is  his  lookout — he  can  take  sleeping  potions  if  he  wants  them.  If 
sleeplessness  subsides  by  changing  the  mode  of  life,  that  is  the 
proper  thing  to  do;  similarly  if  others  find  they  are  able  to  sleep 
under  good  air  conditions  they  should  make  a  change. 

Mucus  Formation.  An  excessive  mucus  formation  is  common 
in  simple  catarrh,  so  frequent  in  people  who  inhale  irritating  mat- 
ter. The  mucus  is  sent  out  to  protect  the  delicate  membranes  and 
to  entangle  the  irritating  matter;  when  enough  has  accumulated 


280  DUSTY   AIR   AND  ILL   HEALTH. 

it  is  spat  out.  This  subject  has  been  treated  under  Colds  and 
Catarrh.  Unfortunately  some  individuals  with  cardio-vascular  dis- 
turbance have  no  mucus  formation  and  do  not  spit ;  everything 
inhaled  seems  to  remain  in  the  body.  Mucus  formation  is  most 
common  in  the  throat.  It  is  also  common  in  the  stomach.  If  a 
certain  cause  is  known  to  produce  it,  the  proper  treatment  is  to 
avoid  the  cause.  If  that  is  not  done  the  simple  mucus  formation 
is  usually  followed  by  pus;  when  this  has  gone  to  the  point  of 
corroding  a  blood  vessel  and  there  is  a  spitting  of  blood,  the  warn- 
ing is  heeded,  but  unfortunately  often  too  late. 

Pain.  There  is  scarcely  a  letter  of  the  alphabet  under  which 
a  number  of  remarks  on  symptoms  can  not  be  made,  but  this  is  not 
the  place  to  attempt  a  systematic  enumeration.  The  subject  of 
pain  itself  could  be  considered  in  many  pages.  Pain  above  all 
other  symptoms  is  beneficent  (with  exceptions,  of  course).  We  see 
this  in  the  case  of  a  broken  bone.  "With  the  least  movement  there 
is  intense  pain,  that  means  to  keep  quiet ;  in  proportion  as  there 
is  immovability  the  broken  bone  knits  together  and  is  perhaps  as 
serviceable  as  ever.  When  the  stomach  is  inflamed  or  injured  or 
irritated,  there  is  pain  when  food  is  put  into  it;  that  means  to 
keep  food  out  until  the  damage  is  repaired.  The  sick  dog  goes  in 
hiding  and  refuses  to  eat. 

There  are  many  different  kinds  of  pain,  different  names.  There 
is  a  "pain  of  the  nerves,"  so-called  neuralgia.  This  is  sometimes 
said  to  be  a  "cry  of  the  nerves  for  pure  blood,"  often  it  is  only  a 
call  for  pure  air.  The  pain  may  disappear  along  with  any  defi- 
ciency in  the  blood  or  "impure  blood."  Then  there  is  a  form  of 
pain  known  as  "rheumatic,"  but  this  may  not  at  all  mean  real 
rheumatism.  I  feel  convinced  that  much  of  the  common  rheumatic 
pain  is  simply  a  reaction  to  bad  air  conditions ;  the  warnings  should 
be  heeded.    When  pain  is  very  severe  it  usually  is  heeded. 

A  pain  in  the  back  does  not  ordinarily  mean  Bright 's  disease 
but  may  mean  dust  infection.  Some  individuals  have  acute  pains 
at  the  site  of  an  old  injury,  as  during  an  acute  attack  of  dust  in- 
fection.    Such  a  pain  may  be  a  veritable  barometer  and  the  indi- 


CAKDIO-VASCULAR    AFFECTIONS.  281 

cations  should  be  properly  read.  Some  pain  is  of  course  purely 
psychical,  perhaps  the  result  of  misdeeds  and  the  fear  of  being 
discovered;  here  there  may  be  a  clear  relationship  of  cause  and 
effect  and  of  the  remedy. 

Skin  Symptoms.  Symptoms  connected  with  the  skin  occur  in 
variety.  The  face  may  be  a  good  index  of  "bodily  conditions  and 
states  of  health,"  yet  some  dust  victims  "look  healthy"  and  get 
no  sympathy — so  they  suffer  in  silence. 

Dryness  of  the  skin  is  common  in  those  with  chronic  ill  health 
and  on  the  other  hand  in  many  acute  diseases  excessive  perspira- 
tion is  common.  Perspiration  comes  on  from  various  causes,  as 
undue  exertion,  either  bodily  or  mental.  In  the  man  unaccustomed 
to  physical  exercise  any  undue  exertion  may  turn  to  heat  and  per- 
spiration; gradual  exercise,  increased  from  day  to  day,  prevents 
this.  In  the  palms  of  the  hands  blisters  form  readily  on  hard  man- 
ual application,  as  after  rowing;  the  soft  skin  is  not  adapted  and 
rebels.  By  going  about  it  gradually,  exercising  a  little  every  day, 
the  skin  adapts  itself,  it  becomes  hardened  and  calloused.  Muscles 
at  first  flabby  soon  become  hardened  and  solid.  These  are  adapta- 
tions. 

The  question  of  "becoming  hardened"  to  bad  air  conditions  is 
an  interesting  one.  We  all  have  heard  how  the  Indian  is  "hard- 
ened" so  that  his  whole  body  is  like  the  white  man's  face,  "all 
face" — and  yet  the  Indian  does  not  thrive  under  the  conditions 
under  which  the  white  man  lives  in  cities.  Parents  who  attempt 
to  "harden"  their  children  by  little  clothing  and  by  exposure  to 
cold  and  giving  cold  baths  may  unconsciously  enough  be  going  on 
the  theory  of  "cure  or  kill."  Those  able  to  stand  such  a  "hard- 
ening process"  may  be  nothing  more  than  the  survivals  of  the 
fittest,  the  unfit  perish — better  dress  children  warmly  and  avoid 
undue  exposure. 

In  dust  victims  flushing,  a  sense  of  heat  in  the  face,  is  very 
common.  I  tell  my  patients  it  should  be  regarded  as  a  warning 
to  stay  away  from  crowded  places  where  the  air  is  bad.  Many  dust 
victims  have  an  eruption  of  the  skin,  pimples.    One  may  personify 


282  DUSTY    AIR    AND    ILL    HEALTH. 

Nature  and  say  that  is  the  way  she  teaches  an  individual  to  remain 
in  seclusion.  A  dust  victim  under  good  air  conditions  may  find 
that  his  face  will  soon  clear  up.  This  is  a  good  argument  for  those 
who  are  fond  of  dances  or  theaters;  their  complexion  clears  up 
when  they  live  in  good  air. 

Sallowness  may  be  regarded  as  a  warning,  as  a  conservative 
process.  People  when  told  they  "look  bad"  are  apt  to  make  some 
sort  of  an  effort  to  better  their  complexions,  and  that  usually  means 
their  health. 

When  I  was  a  boy  of  about  twelve  I  had  a  chum  who  every 
Saturday  afternoon  blacked  the  family  shoes.  Occasionally  I 
would  help  him,  so  he  could  play  with  me.  One  day  he  said,  "If 
this  shoe  had  a  white  spot  on  it  that  nobody  could  get  off,  I  could 
get  it  off."    How?    "I  would  black  over  it." 

That  is  the  way  some  people  change  their  complexion,  they 
paint  it  over.  Some  "complexion  cures"  merely  form  a  coating 
over  the  skin,  and  that  too  is  the  method  of  many  a  symptom- 
prescribing  doctor  who  apparently  causes  a  symptom  to  disappear. 

To  the  very  scientific  diagnostician  of  diseases,  pain,  as  a  symp- 
tom, is  of  the  utmost  importance,  in  general  we  may  say  all  others 
are  of  secondary  importance.  On  the  other  hand  to  the  general 
practitioner  of  medicine  (not  to  speak  of  the  specialist,  the  derma- 
tologist) the  skin  is  of  the  greatest  importance,  because  its  appear- 
ance, in  large  measure  determines  people  to  consult  a  physician. 
Many  will  come  only  when  they  look  bad,  and  when  they  are  not 
benefited  by  advice,  or  medicine,  resort  to  advertised  "cures"  of 
all  kinds — complexion  cures,  pimple  cures,  eczema  cures,  dandruff 
cures,  baldness,  etc. 

Some  people,  women  particularly,  may  ignore  symptoms,  even 
marked  pain — but  a  bad  complexion  is  likely  to  be  heeded.  A 
"bad  complexion"  may  be  considered  a  warning  that  something  is 
wrong  in  the  body,  the  skin  merely  reflecting  it.  Symptoms  are 
variously  classifiable.  Some  manifest  themselves  locally,  others 
generally  or  in  some  distant  organ.  Formerly  we  heard  much  of 
reflexes. 


CARDIO- VASCULAR   AFFECTIONS.  28 .'j 

Some  symptoms  are  modifiable,  others  not,  they  will  cither  be 
present  or  absent.  In  many  diseases  there  are  characteristic  symp- 
toms with  a  variable  number  of  secondary  or  minor  ones,  often 
largely  dependent  on  environment.  The  tone  or  appearance  of  the 
skin  may  be  an  index  of  the  general  health.  The  man  or  child  with 
a  "bad.  color"  or  "sickly  appearance"  may  go  to  the  country, 
seashore  or  mountains,  and  in  a  short  time  return  home  with  a 
different-looking  skin,  perhaps  tanned,  and  then  we  may  hear  of 
a  "healthy  color."  Such  observations  are  of  course  only  "skin 
deep."  Our  school  children  during  the  closed  door  season  acquire 
sickly,  sallow  complexions,  not  to  speak  of  actually  becoming  dis- 
abled. It  is  remarkable  how  they  improve  during  the  summer 
vacation — and  how  they  relapse  the  next  fall  or  winter.  Why  do 
not  parents  inquire  into  the  causes  or  reasons? 

The  hair  and  teeth  in  their  development  are  derived  from  the 
skin,  as  any  embryologist  will  explain.  The  evolutionist  might 
make  any  number  of  remarks  on  changes  in  skin,  hair  and  teeth 
incident  to  civilization,  getting  away  from  the  simple  life. 

The  loss  of  teeth,  of  hair,  and  the  loss  of  contractility  of  the 
blood  vessels  in  the  skin  are  incident  to  our  altered  mode  of  living. 
Soft  food  and  a  mouth  full  of  bacteria  are  detrimental  to  teeth. 
Tight  headcovering,  compressing  blood  vessels  and  excluding  light 
and  air,  and  using  comb  and  brush  full  of  germs  of  all  kinds  (men 
in  barber  shops)  are  all  factors  in  baldness.  Primitive  people  do 
not  know  of  premature  baldness.  "Warm  clothing  and  living  in 
warm  houses  means  a  less  active  cutaneous  circulation.  In  many 
indoor  dwellers  the  skin  seems  to  have  lost  this  important  func- 
tion to  a  large  degree — a  fatal  defect  in  cardio-vascular  cases ;  the 
altered  skin  can  not  aid  the  failing  kidneys. 

Gray  hair  is  a  sign  of  advancing  age.  To  pull  out  the  first 
gray  hairs  does  not  retard  the  process  of  growing  old,  no  more 
than  dyeing  the  hair;  neither  does  painting  the  skin  help.  But  a 
good  set  of  artificial  teeth  has  been  a  boon  to  many  a  person  in 
enabling  him  to  properly  masticate  his  food  (often  too  well,  leading 
him  to  overeat). 


284  DUSTY    AIR    AND   ILL    HEALTH. 

Tinnitus.  Buzzing  in  the  ears  is  a  symptom  due  to  a  variety 
of  causes,  a  very  common  one  being  an  excessive  use  of  quinine,  so 
freely  taken  by  many.  To  avoid  the  cause  means  to  avoid  the 
effect.  Quinine  is  rarely  indicated  and  should  be  token  only  when 
prescribed  by  a  physician ;  when  it  disagrees  he  can  likely  give  a 
substitute.  People  use  quinine  for  colds  when  the  proper  remedy 
is  good  air. 

Buzzing  in  the  ears  is  very  common  in  city  people ;  many  as- 
cribe it  to  noise,  but  more  commonly  it  is  due  to  dust.  Tinnitus 
may  be  regarded  as  a  veritable  dinning  into  our  ears  to  get  out  of 
an  unsanitary  environment.  Many  of  my  patients  have  found 
it  so. 

Only  the  other  day  I  met  one  of  my  old  patients  who  was 
greatly  annoyed  by  a  buzzing  in  one  of  his  ears  during  the  closed 
door  season.  He  spent  last  winter  in  Florida,  led  an  outdoor  life 
and  did  not  notice  any  buzzing  at  all  until  he  returned.  He  has 
now  practically  decided  to  spend  his  winters  in  a  warmer  climate. 

Vomiting.  This  goes  hand  in  hand  with  the  first  symptom 
mentioned,  loss  of  appetite.  If  the  stomach  is  irritated  or  de- 
ranged, Nature  takes  away  the  appetite.  If  a  foolish  man  per- 
sists in  forcing  food  down,  it  is  vomited  up,  just  as  irritants  gen- 
erally are  vomited  up.  The  early  morning  vomiting  has  already 
been  referred  to  as  frequently  being  connected  with  the  spitting 
up  of  dust-laden  mucus.  It  usually  disappears  promptly  on  hav- 
ing good  air  in  the  sleeping  room  at  night,  or  if  need  be  also  good 
air  in  the  day  time. 

"Weak  Heart/'  Here  I  am  not  attempting  to  make  a  sys- 
tematic enumeration  of  symptoms,  of  which  there  are  a  large  num- 
ber, but  one  must  at  least  refer  to  "weak  heart"  as  a  supposed 
symptom  of  heart  disease.  Some  people,  patients,  are  told,  "You 
must  be  exceedingly  careful,  you  have  a  weak  heart,"  We  may 
ask,  Why?  Why  do  people  have  weak  hearts?  Or  shall  we  ask 
a  patient  who  says  he  has  a  "weak  heart,"  How  do  you  know? 

Some  people  have  weak  arms  and  legs.     Reason,  lack  of  exer- 


CARDIO-VASCTTLAR   AFFECTIONS.  285 

cise.  Some  people  have  weak  or  feeble  intellects.  Some  are  born 
so  but  more  often  the  reason  is  failure  to  exercise  the  brain.  Some 
people  have  "weak  hearts"  because  they  fail  to  exercise  and  give 
the  heart  muscles  some  work  to  do.  Muscular  tissue  when  not  used 
becomes  flabby.  The  heart  is  a  muscular  organ,  often  it  is  the  last 
organ  to  fail. 

But  every  physician  knows  that  the  advice  to  take  physical  ex- 
ercise must  be  given  cautiously.  At  the  one  extreme  are  those  to 
whom  we  can  readily  say,  What  you  need  is  exercise,  lots  of  it. 
At  the  other  extreme  are  those  who  must  be  advised  very  cau- 
tiously, where  the  heart  muscle  has  degenerated  to  such  an  extent 
that  vigorous  exercise  is  apt  to  be  fatal  at  once,  embodied  in  the 
saying,  Do  not  run  after  a  street  car.  This  also  applies  to  the  man 
with  a  high  blood  pressure  to  whom  sudden  exercise  may  be  fatal. 
Between  these  extremes  there  are  all  sorts  of  eases  where  the  phy- 
sician must  carefully  discriminate.  On  the  one  hand  there  is  dan- 
ger of  overestimating  and  on  the  other  hand  of  underestimating 
conditions  and  requirements.  A  supposed  weak  heart  may  really 
be  a  strong  one  and  the  opposite  may  be  true. 

In  some  individuals  (those  with  hypertension)  the  heart  may 
be  exhausting  itself  in  working  against  an  excessively  high  blood 
pressure — comparable  to  using  a  force  pump  when  an  easy  work- 
ing pump  only  is  required.  The  strain  of  keeping  the  blood  in 
circulation  may  be  all  the  heart  can  do;  physical  exercise,  work, 
may  promptly  bring  on  dyspnea  and  that  means  to  desist.  But 
the  high  pressure  individual  may  find  that  he  can  breathe  well  in 
good  air — and  that  may  be  the  solution  for  his  difficulties,  if  he  will 
only  heed  the  warnings. 

Worry.  And  what  shall  be  said  of  worry?  One  of  the  pet 
symptoms  of  the  patent  medicine  man,  of  the  symptom-prescriber 
and  of  the  faith  and  mind  curist  is  worry. 

Worry  is  an  old  word;  it  goes  back  to  times  when  life  was 
simple,  then  worry  meant  to  choke  or  suffocate.  It  was  applied 
to  an  actual  struggle,  a  taking  hold  of  the  throat.  But  in  the 
course  of  time  the  term  was  applied  to  a  mental  state  or  condition 


286  DUSTY    AIR    AND   ILL    HEALTH. 

without  perhaps  a  basis  in  fact.  Today  most  of  our  worries  are 
"in  the  mind." 

People  living  the  simple  life  have  few  worries;  those  leading 
the  strenuous  life  under  complex  surroundings,  as  in  our  crowded 
industrial  cities,  have  many  worries,  beginning  with  worry  to  make 
ends  meet.  But  there  are  people  who  have  such  a  desperate  strug- 
gle for  existence  that  they  have  no  time  to  worry,  at  least  they  do 
not  worry  to  the  extent  of  those  having  ample  time,  and  perhaps 
also  a  vivid  imagination,  and,  shall  we  add,  no  proper  conception 
of  the  relationship  of  cause  and  effect. 

I  do  not  continually  tell  my  patients  not  to  worry,  for  if  they 
feel  better  they  naturally  cease  to  worry.  Worry  is  often  depend- 
ent on  environment,  it  is  often  only  a  symptom  of  ill  health.  In 
many  cases  change  of  environment  is  the  remedy. 

Properly  considered  worry  is  a  beneficent  symptom.  Worry 
should  lead  the  wrorried  one  to  look  for  causes — and  then  apply 
the  proper  remedy. 

Symptoms  vs.  Affections.  To  draw  a  line  between  symptoms 
and  affections  is  difficult,  because  symptoms  shade  off  into  affect- 
ions or  disorders,  into  minor  maladies  and  of  course  into  diseases. 
For  instance,  a  loss  of  appetite  may  change  into  a  something  more 
than  a  mere  symptom,  just  as  the  lack  of  blood  may  mean  more 
than  a  mere  symptom,  and  as  a  high  blood  pressure  may  in  time 
be  followed  by  a  condition  known  as  an  arterio-sclerosis.  A  per- 
sistent irritation  of  the  air  passages  may  result  in  bronchitis,  just 
as  a  persistent  purulent  catarrhal  process  may  be  followed  by  the 
production  of  much  scar  tissue  with  a  permanently  altered  lining 
of  the  air  passages  or  of  the  stomach.  Repeated  dyspeptic  attacks 
may  eventually  terminate  in  a  well-defined  disorder,  in  a  perma- 
nent impairment  of  the  digestive  function.  It  would  seem  that 
most  of  the  common  affections  or  minor  maladies  of  civilized  life 
are  dependent  on  environmental  influences,  especially  air  condi- 
tions, and  that  means  that  they  are  largely  preventable. 

Common  affections  like  common  symptoms  may  also  be  looked 


CARDIOVASCULAR   AFFECTIONS.  287 

upon,  especially  in  their  early  stages,  as  conservative   processes, 
teaching  man  to  do  one  thing  and  to  avoid  another. 

Diseases  vs.  Affections  vs.  Symptoms.  Some  symptoms  have 
a  variety  of  causes,  just  as  many  affections  have  a  variety  of  causes. 
On  the  other  hand,  diseases,  that  is,  specific  diseases,  may  he  due 
to  one  definite  cause.  We  need  only  think  of  such  diseases  as 
typhoid  fever,  tuberculosis,  malaria,  etc.  In  the  absence  of  the 
specific  cause  there  is  no  disease.  By  eradicating  the  cause  a 
country  can  be  kept  free  from  such  diseases.  In  early  days,  be- 
fore the  rise  of  sanitation,  there  were  many  diseases  now  known 
only  by  name.  Cleaning  up,  making  cities  sanitary,  has  caused  their 
disappearance.  The  sanitarian  emphatically  insists,  Let  us  clean 
up.  Today  when  we  are  threatened  with  certain  diseases,  notably 
cholera,  our  cities  immediately  get  busy  cleaning  up.  They  know 
that  in  proportion  as  they  do  clean  up,  they  will  escape.  They  no 
longer  ascribe  a  "visitation"  to  Providence  and  those  who  say  Let 
us  pray  are  becoming  fewer  and  fewer.  A  city  may  continue  to 
use  bad  water,  but  the  moment  cholera  or  typhoid  fever  in  epi- 
demic form  appears  an  effort  is  made  to  get  a  better  water  supply. 
Perhaps  after  all  many  of  the  great  epidemic  diseases  are  blessings 
in  disguise,  they  teach  us  to  clean  up. 

Unfortunately  some  diseases  have  gotten  a  good  hold  and  are 
taken  as  a  matter  of  course,  notably  tuberculosis,  and  no  proper 
attempts  toward  eradicating  the  disease  are  made.  Cleaning  up 
and  giving  the  people  good  air  would  cause  tuberculosis  largely  to 
disappear,  along  with  a  host  of  affections  scarcely  rising  to  the  dig- 
nity of  disease.  Many  diseases  have  come  in  and  flourish  just  like 
weeds,  simply  because  we  have  neglected  them. 

Aches  and  pains,  ill  health  and  disease  are  very  common  under 
crowded  and  unsanity  city  conditions.  Should  symptoms  be 
heeded?  Should  they  be  looked  upon  as  evils,  or  as  warnings  from 
nature?  The  philosophical  likely  heed  them  and  in  so  doing  live 
on  and  on.  Those  who  do  not  heed  them  perish  prematurely.  The 
heedless  form  a  type  that  is  not  apt  to  survive.    On  the  other  hand 


288  DUSTY    AIR    AND   TLL    HEALTH. 

it  is  a  well-known  fact  that  chronics  often  outlive  their  physicians. 
The  reason  may  not  he  far  to  seek :  the  chronic  is  constantly  warned 
by  his  pains  and  aches;  he  never  goes  to  extremes.  If  he  finds  a 
certain  cause  produces  a  certain  effect,  he  avoids  that  cause.  What 
many  chronics  need,  as  I  have  attempted  to  show  in  my  case  re- 
ports, is  good  air. 

This  view  may  be  considered  a  philosophical  one.  It  shows  the 
importance  of  cleaning  up.  Such  a  view  is  diametrically  opposed 
to  the  teachings  of  the  faith  curists  who  say  symptoms  and  disease 
are  imaginary. 

The  patent  medicine  man  will  also  disagree.  He  looks  upon 
symptoms  differently;  to  him  a  loss  of  appetite  means  the  taking 
of  his  "tonic"  to  create  an  appetite  and  "eat  anything  you  want." 
To  him  backache  spells  Bright 's  disease  and  he  advises  the  indi- 
vidual to  dope  himself  with  his  nostrum.  Cough  is  something  to 
be  "cured."  Pain  is  a  something  to  be  "killed."  And  thus  the 
poor  and  ignorant  who  get  their  medical  knowledge  from  the  pat- 
ent medicine  advertisements  get  the  worst  of  it.  The  evolutionist 
may  console  himself  with  the  thought  that  in  time  all  these  indi- 
viduals will  be  killed  off — for  the  betterment  of  the  race.  Intelli- 
gence and  prudence  pay. 

From  the  standpoint  of  the  evolutionist  it  would  also  appear 
that  those  wTho  react  to  their  environment  are  of  the  type  that  will 
prevail.  One  can  reason  from  analogies  among  animals,  those  of 
new  countries  or  islands  that  do  not  fear  man  are  destroyed;  in 
proportion  as  they  do  fear  him  and  avoid  him  the  species  is  per- 
petuated. Many  species  of  animals  have  been  exterminated  in 
recent  years  simply  because  they  did  not  fear  man  enough.  Sim- 
ilarly men  who  fear  disease,  and  symptoms,  and  flee  from  them,  or 
still  better  through  knowledge  prevent  their  occurrences,  are  of  a 
type  to  survive. 

Perhaps  after  all  there  are  compensations.  Sensitive  people 
can  not  do  as  those  who  do  not  react  to  their  environment;  they 
have  pains  and  aches,  they  are  warned,  and  if  the  warning  is 
heeded,  they  live  on  and  on. 


vm. 

SPECIFIC  DISEASES. 


This  volume  does  not  aim  to  discuss  specific  diseases ;  all  that  is 
attempted  here  is  to  show  how  persons  in  chronic  ill  health  may  learn 
how  to  reduce  ill  health  to  a  minimum,  assuming  that  they  are  influenced 
by  dusty  air  conditions.  In  order  that  the  subject  may  be  better  under- 
stood, it  is  necessary  to  make  a  few  references  to  specific  diseases. 

One  can  draw  analogies  between  diseases  and  plants,  as  practically 
all  our  specific  diseases  like  our  worst  weeds  are  introduced.  Among 
our  worst  weeds  are  a  few  that  are  natives,  but  just  how  many  diseases 
flourished  before  the  white  man  came  to  our  country  is  a  matter  that  will 
never  be  known,  because  there  were  no  competent  observers  among  the 
first  comers.    Only  a  few  diseases  can  be  mentioned  and  commented  upon. 

Milk  Sickness  This  undoubtedly  native  disease  was  formerly  very 
common  and  fatal.  It  is  practically  extinct  in  our  State,  although  a  case 
now  and  then  occurs.1  The  cause  is  found  in  certain  localities,  usually 
damp  shady  places,  often  fenced  off  to  keep  out  stock.  If  cows  get 
in  they  may  contract  the  disease,  known  as  "Trembles,"  and  transmit  it 
to  man,  presumably  through  the  milk — hence  the  name  Milk  Sickness. 
Cutting  down  the  forest  and  letting  in  the  sunlight  seems  to  be  all  that 
is  necessary  to  cause  the  disease  to  disappear,  just  as  many  of  our  native 
plants  disappear  under  the  same  conditions. 

Malaria.  Whether  malaria  existed  in  our  country  before  the  white 
man  came  is  a  problem,  perhaps  not;  most  likely  it  was  introduced. 
Malaria  is  due  to  a  definite  cause,  a  small  ameba  that  lives  in  the  red  blood 
cells  and  destroys  them.  It  requires  for  its  transmission  a  certain  kind  of 
mosquito  (Anopheles).  The  mosquito  before  it  can  transmit  the  disease 
must  have  bitten  some  one  who  has  malaria.  It  can  not  transmit  the  dis- 
ease without  first  getting  it.  It  breeds  in  wet  places;  drainage  causes  the 
breeding  places  to  disappear.  The  use  of  quinine  causes  the  disease  to  dis- 
appear in  man,  and  that  means  mosquitoes  can  not  infect  themselves. 
Moreover  since  the  use  of  screens  has  become  so  common  mosquitoes  are 
kept  out  of  houses.  Hence  by  draining,  by  the  free  use  of  quinine  (we 
know  how  people  are  constantly  dosing  themselves  with  it),  and  by  the  use 

1 1  am  especially  interested  in  this  disease  and  its  active  cause.  Every  now  and  then  I  hear  of 
cases,  both  of  trembles  in  animals  and  milk  sickness  in  man,  but  usually  too  late  to  make  -any  investi- 
gation regarding  the  active  cause,  that  means  especially  to  make  bacterial  cultures. 

Milk  sickness  is  of  especial  interest  to  physicians  of  the  Ohio  Valley,  where  the  disease  formerly 
was  common,  because  Eastern  physicians  who  had  never  seen  cases  denied  its  very  existence. 

[19]  (289) 


290  DUSTY   AIR   AND   ILL   HEALTH. 

Of  screens,  malaria  has  been  reduced  in  its  prevalence  to  such  an  extent 
that  it  most  Unlay  be  classed  Ideally  ;is  a  rare  disease. 

.Malaria  has  been  repeatedly  referred  to  in  this  volume,  because  it  is 
so  commonly  confounded  with  dust  infection.  Some  physicians  realize 
that  some  Of  their  patients  do  not  have  true  malaria,  they  speak  of  "false 
malaria."  a  name  often  synonoiuous  with  dust  infection.  "A  touch  of 
malaria"  is  also  frequently  hoard. 

True  malaria  is  by  some  writers  held  to  have  been  the  cause  of  the 
decline  of  Greek  and  Roman  civilization.  One  almost  feels  Inclined  to 
take  the  view  that  the  "False  Malaria"  which  nourishes  in  cities  and 
towns  today  is  a  powerful  factor  in  present  day  race  suicide. 

Yellow  Fever.  This  is  a  tropical  disease,  also  transmitted  by  a 
mosquito,  one  with  striped  legs  (Stegomyia).  This  mosquito  occurs  in 
the  Southern  States  and  may  occasionally  be  found  as  far  north  as  the 
Ohio  River.  Until  a  few  years  ago  it  was  not  known  how  the  disease 
is  spread  and  all  sorts  of  precautionary  measures  were  taken  during  an 
epidemic,  including  "shot  gun  quarantine."  Three  or  four  years  ago  sev- 
eral Yellow  Fever  victims  passed  through  this  town  on  the  railroad ;  they 
occasioned  no  alarm  whatever.  To  know  how  a  disease  is  transmitted 
means  to  be  able  to  guard  ourselves  and  avoid  needless  precautions  and 
useless  alarms. 

Cholera.  Asiatic  cholera  has  repeatedly  come  to  us  from  tropical 
countries  where  it  is  endemic,  that  is,  where  it  always  occurs.  It  is  now 
kept  out  by  watching  immigrants  at  the  seacoasts,  as  at  this  writing.  The 
disease,  due  to  a  definite  micro-organism,  is  transmitted  by  getting  into 
the  drinking  water ;  it  is  also  spread  by  flies  carrying  fecal  matter  from 
the  sick.  Cities  that  have  good  drinking  water  and  sewers  and  are  cleanly 
generally  have  practically  nothing  to  fear  from  cholera.  The  former 
"cholera  fear"  has  practically  disappeared. 

Leprosy.  A  few  years  ago  the  newspapers  had  much  to  say  regarding 
leprosy  and  the  danger  of  its  gaining  a  foothold.  It  would  seem,  however, 
that  leprosy  is  a  disease  that  has  pretty  well  run  its  course  among  north- 
ern white  people.  Formerly  it  was  very  common  in  Europe  and  leper 
hospitals  were  to  be  found  everywhere.  Today  it  is  a  rare  disease,  and 
yet  the  occurrence  of  a  case  causes  alarm.  It  is  characteristic  of  the 
human  mind  to  become  alarmed  at  possible  dangers  but  to  neglect  real  ones. 
Thousands  die  from  the  ravages  of  a  bacillus  that  is  closely  related  to  the 
lepra  bacillus,  namely  the  tubercle  bacillus,  and  yet  people  take  the 
presence  of  consumption  as  a  matter  of  course. 

Smallpox.  Smallpox  is  another  disease  that  formerly  was  very  com- 
mon but  which  now  is  rare  and  has  lost  its  terrors.  Some  European 
countries  are  very  strict  in  requiring  vaccination  and  as  a  result  smallpox 
is  practically  unknown.     But  there  are  countries  less  strict  and  smallpox 


SPECIFIC  DISEASES.  291 

prevails  accordingly,  pocked  faces  are  quite  common.  Smallpox  was  one 
of  the  first  diseases  introduced  into  our  country.  It  was  very  fatal  to  the 
Indians  who  had  never  heen  accustomed  to  it.  One  can  understand  how 
a  few  out  of  the  hundreds  who  perish  may  leave  offspring  that  is  more  or 
less  resistent  and  that  with  repeated  exposure  of  the  offspring  finally  a 
strain  will  be  produced  that  is  more  or  less  resistent,  just  as  in  the  case 
of  rust  proof  oats.  The  story  of  rust  proof  oats  is  an  interesting  one. 
The  ordinary  farmer  when  he  sees  his  oat  field  suddenly  blighted  plows  it 
under.  But  a  number  of  years  ago  one  man  more  shrewd  than  the  rest 
noticed  that  a  few  stalks  survived.  By  cultivating  the  seed  from  this 
plant  through  successive  generations  he  finally  produced  the  "rust-proof 
oat."  In  the  case  of  man  there  is  another  factor  that  must  be  considered, 
the  admixture  of  more  or  less  immune  blood.  Pure  blood  Indians  are  be- 
coming more  and  more  rare. 

Measles.  Measles  is  a  very  common  disease  of  childhood.  It  has  been 
among  us  so  long  that  it  only  exceptionally  attacks  an  adult.  It  is  so 
mild  a  disease  that  many  parents  neglect  to  call  the  physician  at  all. 
Indeed  in  the  country  children  get  well  without  anything  whatever  being 
done.  But  when  the  disease  attacks  people  who  have  never  had  it,  as  the 
Esquimos  of  the  far  north,  or  islanders  in  the  South  Seas,  whole  tribes 
may  become  extinct.  Such  people  must  undergo  the  process  of  adapta- 
tion. In  this  connection  it  may  be  mentioned  that  the  natives  of  the 
West  Coast  of  Africa  are  in  about  the  same  position  in  regard  to  malaria 
as  we  are  to  measles;  adults  are  immune. 

As  a  rule  school  children  are  free  from  "contagious  diseases"  during 
the  summer  but  the  moment  they  are  massed  in  school  houses  certain  dis- 
eases appear,  notably  measles,  scarlet  fever  and  diphtheria.  Where  chil- 
dren are  massed  closely  as  in  schools  such  diseases  readily  spread.  One 
of  the  most  important  functions  of  the  physician  is  to  make  a  proper 
diagnosis. 

Scarlet  Fever.  This  in  many  respects  resembles  measles  but  is  re- 
garded as  a  degree  more  severe  and  the  child  that  is  neglected  is  apt  to 
perish.  But  it  makes  a  vast  difference  under  what  conditions  scarlet  fever, 
measles,  and  other  diseases,  including  typhoid  fever  and  consumption,  are 
contracted,  and  where  the  victim  lives.  In  the  city  with  all  sorts  of  infec- 
tion about  and  the  body  constantly  engaged  in  fighting  off  infection,  these 
diseases  may  be  quite  severe,  while  they  may  be  mild  in  the  isolated  coun- 
try where  in  spite  of  improper  nursing  and  the  use  of  ordinary  diet  people 
recover.  Indeed  even  the  consumptive  when  sent  out  from  the  city  in 
time  tends  to  get  well. 

Influenza,  known  also  as  La  grippe,  is  a  specific  disease  due  to  a 
definite  cause  (a  small  bacillus)  whose  clinical  manifestations  greatly  re- 
semble those  of  "colds,"  in  fact  to  such  an  extent  that  during  and  after 
the  prevalence  of  an  epidemic  a  large  number  of  cases  are  indiscriminately 


292  DUSTY  AIR  AND  ILL  HEALTH. 

dubbed  "grip,"  especially  by  physicians  who  do  not  discriminate.  Grip 
ordinarily  is  syiuuionious  with  "colds."  Influenza  has  appeared  at  intervals 
of  years  and  attacked  almost  everybody.  The  pandemic  of  1S89-90  was 
especially  severe.  But  manifestations  vary  in  different  individuals.  Most 
commonly  there  is  an  irritation  of  the  respiratory  mucus  membranes  with 
evidences  of  colds  and  catarrh  and  usually  there  is  marked  nervous  de- 
pression. In  some  the  digestive  tract  is  greatly  deranged.  In  others  nerv- 
ous symptoms  predominate.    One  may  speak  of  types. 

The  severity  of  the  disease  is  largely  dependent  on  air  conditions, 
mild  under  good  air  and  severe  under  bad  air.  Pat  made  an  observation 
that  is  verified  by  many:  "Influenza  is  a  funny  disease,  you're  sick  so 
long  after  you  get  well,"  meaning  that  there  are  after  affects.  But  we 
should  keep  in  mind  that  Pat  usually  lives  under  bad  air  conditions,  in 
the  city,  and  that  the  farmer  in  isolation  may  have  an  entirely  different 
story.  Children  at  home  before  and  after  school  age  may  suffer  slightly 
while  those  going  to  school  and  inhaling  bad  air  may  suffer  severely. 
In  the  country  the  disease  is  often  so  mild  that  a  physician  is  not  called. 
^Yhen  Influenza  reaches  a  people  who  have  never  had  it  or  have  not  had 
it  for  a  long  time  it  may  be  a  serious  disease,  killing  many,  as  mentioned 
in  the  case  of  measles.  The  same  is  true  of  other  diseases  to  which  people 
are  not  accustomed. 

Some  diseases  come  to  us  periodically,  but  not  finding  life  conditions 
favorable  again  disappear.  Some  diseases  are  actively  combatted  and  kept 
down,  as  mentioned  under  cholera.  There  is  another  disease  that  flour- 
ishes in  overcrowded  communities  where  sanitation  is  neglected  that  should 
be  mentioned,  namely  the  Plague.  This  has  several  times  come  near  get- 
ting a  foothold  in  California. 

The  Plague.  The  Plague  is  a  disease  par  excellence  that  flourishes 
with  overcrowding  and  neglect  of  sanitation.  An  extract  from  Woodruff's 
"Expansion  of  Races"  shows  how  the  scientific  student  of  diseases  looks 
upon  some  diseases.  It  emphasizes  the  importance  of  cleanliness  and  pre- 
vention of  overcrowding,  not  only  of  cities  but  of  the  country  as  a 
whole. 

"PLAGUE  AND  DIRT." 

"The  plague  of  India  is  a  direct  result  of  overcrowding  of  indescrib- 
ably filthy  people.  In  Calcutta,  as  many  as  144,000  live  in  one  square 
mile  (London  has  36,000  per  square  mile),  250  living  where  there  are 
accommodations  for  only  fifty,  or  less ;  huts  seven  feet  square  accommo- 
date five  or  more.  The  germ  has  such  ideal  conditions  for  spreading  from 
rats  that  it  can  not  be  eradicated.  The  native  is  so  dirty  in  his  habits 
that  ....  the  British  have  finally  given  up  all  hope  of  forcing 
sanitation  upon  the  Hindu.  Even  when  the  reported  deaths  of  plague 
amounted  to  nearly  30,000  a  week,  they  were  forced  to  allow  the  native 
to  contract  the  disease.  The  strange  new  methods  of  cleanliness  were 
repugnant  to  him  and  often  ran  counter  to  his  religion. 


SPECIFIC   DISEASES.  293 

"According  to  a  writer  in  L'lllustration  (Paris),  it  is  now  generally 
admitted  that  there  is  overpopulation  in  India,  and  that  the  present 
mortality  from  plague  is  a  beneficial  blood-letting.  The  deaths  in  1906 
were  so  numerous  that  the  Government  stopped  reporting  them.  In  1901 
the  number  of  victims  was  275,000;  in  1902,  580,000;  in  1903,  850,000; 
in  1904,  1,025,000— and  the  estimate  for  1905  was  over  2,000,000,  and  1907 
totaled  even  more."     (p.  69.) 

We  are  further  told  about  its  repeated  ravages  in  Europe,  how  at 
times  it  may  have  killed  off  one-quarter  of  the  entire  population,  and  how 
by  the  eighteenth  century  Europe  had  arrived  at  a  stage  of  cleanliness 
where  its  ravages  became  less  and  less. 

".  .  .  .  Plague  is  really  a  disease  of  rats  transmitted  by  fleas,  and 
these  ancient  epidemics  show  bad  sanitation  of  crowds,  for  rats  never 
flourish  except  in  such  conditions."     (p.  70.) 

In  the  light  of  such  descriptions  comments  on  the  ravages  of  our 
specific  diseases  seem  tame,  but  we  do  have  some  diseases  that  are  almost 
as  fatal  as  the  plague  of  India.  We  need  only  think  of  Tuberculosis,  a 
disease  that  flourishes  among  the  poor  living  under  crowded  and  underfed 
conditions,  but  unfortunately  en  account  of  the  spitting  habit  it  also  finds 
victims  among  people  who  live  under  different  life  conditions. 

Tuberculosis.  Tuberculosis  is  a  disease  that  has  long  afflicted  Euro- 
peans and  their  descendants  and  for  ages  has  been  killing  off  the  sus- 
ceptible, until  now  the  average  individual  is  fairly  immune,  unless  condi- 
tions are  very  bad.  It  is  severe  in  families  where  there  was  no  constant 
exposure  and  where  weeding  out  has  not  been  going  on.  It  is  of  course 
more  active  under  crowded,  congested  conditions  than  in  the  open  country, 
not  only  on  account  of  constant  exposure  but  also  on  account  of  the  weak- 
ening of  the  body  under  general  unsanitary  conditions.  If  people  lived 
under  good  air  conditions,  tuberculosis  would  be  a  rare  disease,  afflicting 
only  those  who  are  especially  sensitive,  and  perhaps  largely  maintain 
itself  by  attacking  the  feeble.  Tuberculosis  pure  and  simple  in  an  indi- 
vidual living  under  good  air  conditions  has  few  symptoms,  so  few  that  the 
disease  in  its  early  stages  may  escape  recognition.  A  case  that  is  well 
developed  can  be  diagnosed  by  almost  any  one.  In  proportion  as  indi- 
viduals live  under  bad  air  there  are  many  symptoms.  It  is  an  old  disease, 
well  described  by  the  ancient  Greeks. 

Tuberculosis  or  Consumption  like  many  weeds  has  come  to  us  from 
the  old  world  and  like  them  does  not  thrive  in  clean  communities.  Just 
as  neglected  farms  and  waste  places  are  the  natural  homes  for  weeds, 
from  whence  the  seed  are  spread,  so  neglected  communities  and  the  slums 
of  cities  are  natural  homes  of  tuberculosis.  There  is  a  State  law  that 
compels  the  cutting  of  weeds,  largely  neglected  however  except  by  the 
railways,  but  we  are  only  beginning  to  realize  that  the  breeding  places 
for  consumption  must  also  be  cleaned  up.  Tuberculosis  is  a  disease  that 
has  gained  such  a  foothold  among  us  that  its  presence  is  taken  as  a 


294  DUSTY    AIR    AND   ILL    HEALTH. 

matter  of  course;  we  are  scarcely  alarmed  when  a  neighbor  next  door 
dies,  while  a  case  of  leprosy  or  cholera  in  an  adjoining  county  or  state 
alarms  many. 

What  must  we  do  to  get  rid  of  tuberculosis?  There  are  two  general 
lines  of  procedure.  First,  to  clean  up,  to  make  the  conditions  for  the 
existence  of  tuberculosis  unfavorable,  to  clean  up  slums  and  communities 
and  buildings  generally,  and  give  the  people  good  air.  Consumption  can 
be  banished,  just  as  malaria  has  been  banished  and  as  typhoid  fever  in 
large  cities  has  been  banished.  The  afflicted  should  be  sent  out  where 
they  can  get  good  air;  if  not  too  far  advanced  they  are  apt  to  recover. 
Tuberculosis  is  really  a  protest  against  bad  air  conditions,  just  as  typhoid 
fever  is  a  protest  against  bad  water.  Looked  at  evolutionally,  one  would 
be  inclined  to  say  that  it  serves  a  community  right  to  have  consumption 
and  typhoid  fever  and  malaria.  The  people  themselves  are  to  blame  and 
nature  is  weeding  out  among  them  as  she  has  in  times  past. 

A  second  method  of  getting  rid  of  Tuberculosis  is  by  the  use  of  anti- 
toxins. This  is  a  subject  of  exceeding  interest  to  the  scientific  physician, 
but  unfortunately  he  only  too  often  neglects  the  simpler  method,  cleaning 
up.  Tuberculosis  is  important  to  the  student  of  ill  health,  he  must  con- 
stantly rule  out  its  presence  in  dust  victims,  many  of  whom  end  through 
the  ravages  of  the  tubercle  bacillus,  and,  as  already  mentioned,  more 
particularly  those  who  have  a  low  blood  pressure.  Old  densely  crowded 
countries  with  exhausted  soils  must  constantly  contend  with  starvation ; 
underfed  people  are  numerous.  Today  in  our  country  conditions  are 
gradually  reaching  a  similar  stage  and  the  weeding  out  through  tubercu- 
losis will  go  on  for  a  long  time.1 

Diphtheria.  This  may  be  cited  as  an  example  of  the  anti-toxin  treat- 
ment of  specific  diseases,  both  in  preventing  and  curing  the  disease  through 
the  use  of  its  own  poison,  its  anti-toxin,  just  as  smallpox  may  be  cited 
as  a  disease  preventable  (but  scarcely  curable  unless  resorted  to  very 
promptly)   by  the  use  of  vaccination. 


1  Case  Report.  One  of  my  earliest  patients  was  a  young  farmer  whose  ancestors  were  rura 
Europeans.  Under  bad  air  conditions  the  man  became  afflicted.  There  was  present  cough,  fever, 
free  expectoration  (full  of  tubercle  bacilli)  and  night  sweating,  not  to  speak  of  other  symptoms.  He 
was  promptly  advised  regarding  the  influence  of  "bad  air"  and  the  importance  of  remaining  in  good 
air.  His  symptoms  gradually  subsided  and  tubercle  bacilli  disappeared  in  the  course  of  months. 
For  two  years  he  apparently  was  well.  Then  there  was  another  infection;  this  too  subsided  in  a  year 
or  two.  He  was  now  more  careful.  He  remained  in  apparently  good  health  for  several  years  until 
one  day  in  midwinter  he  had  some  business  at  the  court-house  of  his  county-seat.  That  meant  to  be 
exposed  to  bad  air  all  day.  He  reacted  very  promptly:  there  was  a  marked  "cold,"  followed  by  a 
catarrh,  which  "hung  on."  When  he  returned  he  had  symptoms  of  tuberculosis.  On  examining  the 
sputum  tubercle  bacilli  were  found,  this  settled  the  diagnosis.  The  infection  this  time  was  so  severe 
that  he  did  not  recover.  While  the  active  tubercular  process  was  going  on,  he  came  to  recognize 
clearly  that  symptoms  were  dependent  on  exposure  to  bad  air,  and  needless  to  say,  he  was  very  careful 
not  to  expose  himself,  but  of  course  it  is  almost  impossible  wholly  to  avoid  doing  so.  Such  a  case 
shows  the  marked  difference  between  country  and  city  cases,  the  latter  often  being  harassed  by  a 
variety  of  symptoms. 


SPECIFIC    DISEASES.  295 

Typhoid  Fever.  This  is  another  disease  that  was  early  brought  to 
our  country.  It  is  closely  related  to  typhus  fever  with  which  it  was  long 
confused.  Recently  another  related  disease  was  separated,  paratyphoid 
fever.  Thus  finer  and  finer  distinctions  are  being  made.  What  seemed 
to  be  cases  of  the  same  disease  may  be  found  to  be  something  entirely 
different.  The  treatment  of  different  diseases  may  of  course  differ 
radically. 

Typhoid  fever  is  essentially  a  water-born  disease.  The  active  cause 
gets  into  streams  and  into  wells ;  it  is  also  carried  by  flies,  as  in  the  case 
of  cholera.  It  took  cities  a  long  time  to  learn  that  typhoid  fever  can  be 
prevented  by  the  use  of  pure  water.  Many  cities  have  gone  to  great 
expense  to  get  good  water  from  a  distance  or  else  resort  to  filtration  on  a 
large  scale.  This  is  a  matter  where  the  community  as  a  whole  must  take 
hold ;  the  individual  is  practically  powerless.  Household  filters  are  worse 
than  useless.  Typhoid  fever  is  more  common  in  small  towns  than  in 
large  cities.  Many  a  vacationist  on  returning  to  the  city  brings  back 
typhoid  fever.  The  prudent  man  is  more  and  more  making  inquiries 
before  starting  on  his  vacation;  he  knows  that  many  diseases  are  pre- 
ventable; he  will  not  willingly  or  knowingly  go  to  a  malarial  country  or 
to  a  region  where  yellow  fever  or  cholera  occurs,  nor  will  he  go  to  a 
community  where  typhoid  fever  prevails. 

Just  now  we  hear  more  or  less  of  vaccination  against  typhoid  fever, 
the  special  scourge  of  soldiers  in  camp.  Under  changing  camp  life,  it  is 
simpler  to  vaccinate  than  to  take  constant  precautions  in  getting  water 
free  from  typhoid  germs,  but  such  an  argument  does  not  apply  to  people 
of  the  city;  there  people  are  fixed  to  their  homes  and  not  constantly  mov- 
ing about  and  there  water  furnished  should  be  pure.  The  importance  of 
a  pure  water  supply  is  well  known.  Backward  communities  are  still  too 
common. 

Typhoid  fever  is  a  disease  due  to  a  definite  micro-organism,  or  germ, 
with  a  variable  number  of  symptoms.  The  textbooks  mention  a  large  list 
but  it  should  be  kept  in  mind  that  the  textbooks  as  a  rule  are  written  by 
city  men,  based  on  city  cases,  especially  on  city  hospital  cases,  and  that 
means  in  turn  people  who  live  under  bad  ai'r  conditions.  The  mortality 
rate  in  cities  and  in  city  hospitals  is  high.  In  the  country  the  disease 
generally  runs  a  mild  course  and  in  spite  of  poor  nursing  and  improper 
food  patients  tend  to  get  well.1     Under  good  air  many  of  the  acconipany- 


1  The  following  from  my  paper  on  Atypical  Cases  and  Dust  Infection  (American  Medicine,  Oct.  1, 
1904)  may  be  pertinent: 

In  some  cases  the  inhalation  of  dust  simply  acts  as  a  modifier  of  the  symptoms  of  disease.  The 
behavior  of  a  typhoid  fever  case  in  a  city  with  a  dusty  atmosphere  differs  from  that  of  one  in  the 
country  with  a  pure  air — the  constant  slight  efforts  of  coughing  and  clearing  the  throat  may  be  wholly 
absent  in  the  latter  case,  and  respiratory  diseases,  like  bronchitis,  laryngitis,  pneumonia,  pleurisy, 
tuberculosis,  etc.,  are  less  apt  to  carry  the  patient  off.  Indeed,  it  would  seem  that  among  the  first 
things  to  do  in  the  treatment  of  typhoid  fever  (as  well  as  of  other  exhausting  diseases)  would  be  to 
place  the  patient  in  a  good  atmosphere. 


296  DUSTY    AIR    AND    ILL    HEALTH. 

ing  symptoms  are  wholly  absent  and  the  country  doctor  is  often  in  doubt 
whether  he  is  really  dealing  with  typhoid  fever.1  It  is  only  within  recent 
years  that  a  test  has  been  devised  that  will  enable  him  to  determine 
definitely.    The  test  is  made  by  the  use  of  a  few  drops  of  blood. 

An  observant  old  country  doctor  located  in  a  small  village  surrounded 
by  intelligent  farmers  told  me  he  has  less  and  less  to  do  each  year  with 
"filth  diseases"  and  ill  health  depending  on  unsanitary  surroundings.  His 
explanation  was  simple:  The  people  are  learning  to  clean  up  generally. 
Many  get  "'Farmer's  Bulletins*'  of  all  kinds  in  which  they  are  told  how  to 
take  care  of  their  animals,  not  to  speak  of  crops ;  they  have  learned  that, 
it  pays  to  look  after  things — and  they  apply  the  knowledge  to  themselves. 
What  is  good  for  beast  is  also  good  for  man. 

Pneumonia.  Lobar  pneumonia  or  "real  pneumonia"  is  popularly  rec- 
cognized  as  a  disease  that  usually  follows  a  "cold ;"  professionally  it  is 
considered  a  disease  that  seeks  out  robust  men ;  it  has  been  designated  as 
the  Captain  of  Death.  In  some  cities  it  outranks  all  other  causes  of 
death ;  it  is  widely  prevalent  during  the  closed  door  season. 

The  popular  belief  that  pneumonia  follows  a  cold  is  frequently  men- 
tioned by  the  patent  medicine  men.  "Beware  of  a  cold,"  they  say — and 
at  the  same  time  they  advise  taking  their  nostrums  "to  cure  a  cold  and 
prevent  pneumonia."2 

Pneumonia  is  a  rare  disease  under  good  air  conditions  and  is  readily 
"amenable  to  treatment,"  with  a  low  death  rate.  Some  country  doctors 
say  they  have  little  difficulty  in  successfully  treating  their  cases  and  in 
shortening  the  disease,  which  the  city  doctors  deny.  If  we  consider  the 
difference  in  environment  one  may  see  why  there  are  such  divergent  views. 

Pneumonia  does  not  occur  in  a  new  country  until  it  is  introduced,  no 
more  than  other  "germ  diseases."  The  "pneumococcus"  is  a  very  minute 
plant,  a  bacterium,  that  can  be  grown  artificially  in  test  tubes,  just  as 
large  plants  can  be  grown  in  the  greenhouse  or  in  the  garden.  Introduced 
diseases  like  introduced  plants  thrive  only  if  the  conditions  are  favorable : 
if  not  they  perish. 

Pneumonia  flourishes  where  people  are  massed  under  bad  air,  one  may 
speak  of  hotbeds  of  disease.  We  may  say  that  the  prevalence  of  pneu- 
monia is  a  good  index  of  unsanitary  air  conditions,  just  as  typhoid  fever 
is  an  index  of  unsanitary  water. 

In  this  volume  the  writer  is  telling  about  things  "here  at  home."  It 
is  not  his  intention  to  tell  about  things  in  distant  countries.     One  is  re- 


1  Our  newspapers  frequently  speak  of  people  being  "threatened  with  typhoid  fever,"  and  yet  in 
a  day  or  two  they  may  be  about  as  usual.  The  question  then  arises,  What  really  was  the  matter? 
According  to  my  experience  such  "threatened"  cases  are  often  acute  attacks  of  dust  infection. 

3  Having  twice  had  this  disease  myself,  once  in  childhood  and  once  since  a  physician,  I  have 
naturally  been  inquiring  under  what  conditions  it  occurs,  and  that  means  at  the  same  time  how  to  prevent 
it.     Here  again  the  matter  of  good  air  and  cleaning  up  crops  out  very  strongly. 

While  physician  among  the  insane  I  was  struck  by  the  rarity  of  pneumonia  among  the  hospital 
inmates.    The  reason  is  simple:  great  cleanliness  and  an  abundance  of  good  air  day  and  night. 


SPECIFIC   DISEASES.  297 

minded  of  Samuel  Johnson :  "Nay  don't  give  us  India.  That  puts  me  In 
mind  of  Montesquieu,  who  is  really  a  fellow  of  genius  too  in  many  re- 
spects; whenever  he  wants  to  support  a  strange  opinion,  he  quotes  you 
the  practice  of  Japan,  or  of  some  other  distant  country,   of   which   he 

knows  nothing "     But  the  following  clipping  from  a  newspaper 

article  of  several  years  ago  relates  to  our  own  country.  It  shows  how 
pneumonia  was  brought  to  a  previously  "healthy  country"  and  how  on 
account  of  favorable  conditions  it  readily  increased  and  found  many  vic- 
tims. The  lack  of  an  abundance  of  water  to  clean  up  properly  is  an  im- 
portant factor.  The  closing  paragraph  is  very  suggestive ;  the  conditions 
under  which  men  sleep  tell  the  story.  If  those  men  had  clean  tents  to 
live  in  the  mortality  rate  would  quickly  subside. 

DEATH   IS   SUDDEN;    WEALTH   IS  QUICK. 


Pneumonia  Becomes  the  Scourage  of  the  Nevada  Gold  Hunters. 


DEATHS    EIGHTY    A    MONTH. 


Goldfield  the  Gathering  Place  of  Thousands  of  Adventurers. 


Goldfield,  Nev.,  January  5. — There's  a  terrible  little  fellow  who  seems 
to  have  been  appointed  by  the  spirits  of  the  desert  to  keep  ward  and 
watch  over  the  golden  treasure  buried  in  the  barren  hills  of  bleak  Ne- 
vada. He  is  the  Pneumococcus.  The  treasure  hunters  are  slowly  besting 
him,  but  the  little  demon  is  exacting  a  heavy  payment  for  the  gold  they 
take  away. 

Pneumonia  is  the  scourge  of  Goldfield.  Deaths  in  the  mining  camp 
run  from  60  to  100  a  month.  Call  it  an  average  of  80  and  you  have  a 
yearly  death  rate  of  6  per  cent.  A  very  large  majority  of  these  deaths  are 
due  to  pneumonia,  a  few  to  typhoid. 

The  outside  world  hears  little  of  it  save  when  some  well-known  man 
passes  away,  such  as  ex-Governor  Hunt  of  Idaho,  who  succumbed  here  to 
the  scourge  of  the  camp.  Most  of  the  victims  are  homeless  and  friendless 
adventurers.  No  fuss  is  made  over  them.  They  are  simply  taken  out  and 
buried  in  the  most  God-forsaken  cemetery  in  all  the  world. 

In  most  of  the  victims  life  goes  out  like  a  snuffed  candle.  So  swiftly 
death  rides  on  the  wings  of  Pneumococcus  that  they  call  it  black  pneu- 
monia down  here.  But  it's  only  old-fashioned  pneumonia  working  the 
more  swiftly  that  it  has  such  fertile  soil  in  which  to  plant  its  seed.  It 
is  intensive  farming,  Death  the  farmer. 

The  hardships  of  this  coalless,  overcrowded  mining  camp  weaken 
constitutions  so  that  when  disease  comes  it  meets  little  resistance.  In 
four  saloons  late  last  night  a  correspondent  counted  sixty-eight  men  asleep 


'298  DUSTY    AIR    AND    ILL    HEALTH. 

on  the  floor.  Some  were  drunk  and  some  were  merely  exhausted  with  toil 
and  had  no  other  place  where  they  could  sleep. 

Out  of  the  kindness  of  their  hearts  the  bartenders  let  them  sleep 
where  they  lay.  Occasionally  a  man  with  a  mop  would  approach  one  of 
the  sleepers  and  i>oke  him  into  seini-wakefuluess. 

"Hey,  Bill."  he  would  say,  "roll  over  till  I  mop  beneath  ye." 

The  sleeper  would  obey  orders,  returning  to  slumber  the  next  instant, 
while  the  mop  continued  its  work  under  the  next  man  and  the  whirr  of 
the  roulette  ball,  the  popping  of  many  corks  and  the  volleys  of  profanity 
in  many  tongues  blended  for  the  slumberer's  lullaby.  It  is  men  of  this 
sort  that  are  dying  like  sheep  in  Goldfield.  They  are  shipping  two  or 
three  of  them  out  on  every  train,  others  they  bury  in  nameless  graves; 
the  hospital  is  full  and  the  undertaker  cheerful. 

The  newcomer  wonders  why  there  is  a  graveyard  so  near  the  middle 
of  the  town.  This  the  story  of  how  it  happened,  related  by  one  of  the 
oldest  inhabitants  of  the  Goldfield  settlement : 

"When  I  first  blew  in  here  nobody  had  ever  cashed  in.  A  few  days 
later  some  fellow  croaked.  He'd  no  money,  no  friends,  no  name  that  any- 
body knew  of. 

"So  a  few  of  us  thought  it  was  up  to  us  to  plant  him.  I  was  on  the 
committee  to  pick  out  a  cemetery  site.  We  found  a  place  out  on  the 
desert  about  a  mile  from  town.    Then  we  gave  a  man  $5  to  dig  the  grave. 

"Jake  Murnan  was  the  fellow  we  picked  for  the  job.  Jake  was  drunk 
and  broke.    He  hated  to  let  his  jag  die,  so  a  fivespot  looked  big  to  him. 

"I  took  him  out  and  showed  him  the  place  and  Jake  came  back  to 
get  a  shovel  and  a  pick.  On  the  way  back  he  comes  on  a  hole,  six  by  eight 
feet,  that  some  prospector  had  made  and,  being  some  tired,  he  figures  that 
this  is  just  as  sightly  a  place  for  a  grave  as  the  one  we  picked  out.  So 
he  digs  it  right  there  in  that  prospector's  excavation. 

"When  we  come  to  bury  the  stranger  we  sees  Jake  has  made  a  break, 
but  we  was  too  busy  to  bother  about  it.     So  we  plants  him  right  there. 

"Course,  the  next  one  was  put  right  next  to  him,  and  so  it  grew  up 
into  a  fine  young  cemetery-     Pretty  soon  we  gets  200  bodies  planted  there. 

"So  we  calls  a  halt  and  starts  another  cemetery  further  out.  But 
Jake  is  responsible  for  the  first  one." 

GOLDFIELD  IS  INDIFFERENT. 

But  it's  little  Goldfield  cares  for  the  man  who  falls.  They  are  rush- 
ing in  every  day  to  take  his  place.  There's  gold  out  there  in  the  desert 
and  the  lucky  ones  will  get  it.  If  you  live,  you  live;  if  you  die,  you  die, 
says  fatalistic  Goldfield. 

If  a  man  were  to  recount  all  the  tales  he  hears  down  hear  of  men 
who  go  to  bed  paupers  and  wake  up  worth  tens  of  thousands  he  would  be 
set  down  as  the  possessor  of  a  singularly  active  imagination.  But  a  great 
many  of  these  yarns  are  true  and  capable  of  demonstration.    For  example : 


SPECIFIC    DISEASES.  299 

[Next  comes  a  column  of  such  examples,  of  men  who  quickly  became 
rich  and  some  who  again  quickly  became  poor.  The  article  closes  as  fol- 
lows:] 

Society  Note:  The  many  friends  of  Tex  Rickard  will  be  interested  to 
hear  that  he  intends  having  his  Northern  saloon  swept  out  next  week. — 

Indianapolis  Star,  January  0,  1907. 

Syphilis,  or  the  Pox,  was  until  recently  rarely  mentioned  in  polite; 
literature  or  referred  to  vaguely  as  "blood  poisoning."  It  is  a  disease  that 
is  transmitted  almost  exclusively  through  contact,  the  parasites  travelling 
from  one  individual  to  another,  especially  through  abraded  mucous  mem- 
branes— the  abolition  of  the  common  drinking  cup  aims  to  avoid  infection 
through  lips  and  mouth. 

This  disease  formerly  ravaged  fearfully  and  still  does,  but  today  "it 
kills  only  poor  people  who  are  friendless" — it  is  considered  a  disgrace  to 
die  from  it.     Often  it  is  innocently  contracted,  especially  by  children. 

Those  who  see  few  cases  underestimate  and  those  who  see  many 
overestimate  the  prevalence  of  this  disease.  In  the  practice  of  the  family 
doctor,  particularly  in  small  communities,  there  is  a  complicating  factor — 
patients  conceal  the  presence  of  the  disease  and  go  elsewhere  to  be  treated, 
perhaps  to  a  quack  who  loudly  advertises  his  ability  to  cure  "blood  poison" 
in  a  short  time. 

Syphilis  is  one  of  the  diseases  that  needs  the  widest  publicity  but 
which  up  to  date  has  received  anything  but  that. 

Another  disease  that  should  be  mentioned  is  gonorrhea.  To  what  ex- 
tent does  it  prevail?  According  to  some  physicians  it  is  not  at  all  com- 
mon, according  to  others  it  is  very  common.  Why  this  discrepancy  of 
opinion?    Here  is  the  explanation  of  one  of  our  observing  physicians: 

The  country  doctor,  unlike  the  city  doctor,  does  not  write  about  his 
cases — he  talks  about  them.  Many  people  know  he  talks  and  when  they 
have  certain  unmentionable  diseases  do  not  go  to  him  but  go  to  the  city 
doctor.  Some  of  the  latter  specialize  or  at  least  give  special  attention  to 
such  cases,  "they  do  not  give  their  patients  away."  Because  the  city  doc- 
tor gets  many  such  cases  he  is  inclined  to  believe  the  world  is  full  of  the 
disease — just  as  the  country  doctor  who  sees  few  cases  has  an  opposite 
opinion.     This  being  so,  the  truth  lies  somewhere  between  extremes. 

There  is  no  need  to  run  over  a  larger  list  of  specific  diseases,  many 
of  which  are  dependent  on  the  neglect  of  cleanliness,  we  need  only  think 
of  lousiness  and  the  itch  and  many  skin  diseases  that  are  transmitted 
among  neglected  children,  or  of  diseases  among  domestic  animals  due  to 
neglect  and  transmissible  to  man,  such  as  worms  of  many  kinds,  including 
tapeworms  and  trichina.  In  some  instances  the  cause  is  so  large  that  any 
one  can  see  it,  in  others  so  minute  that  only  the  highest  power  of  the 
microscope  reveals  it.    High  school  courses  in  elementary  biology  and  bac- 


300  DUSTY    ArR    AND    ILL    HEALTH. 

teriology  and  sanitation  can  not  be  too  common,  and  the  importance  of 
the  influence  of  environment  and  of  Cleanliness  can  not  be  over-emphasized. 

Diseases  in  the  average  civilized  community  are  transmitted  mainly 
through  aiT,  through  contact,  through  food,  through  insects  and  through 
water.  Air  should  be  mentioned  first,  for  we  breathe  it  every  minute  of 
our  lives.  Cities,  as  already  mentioned,  aim  to  get  good  water  supplies, 
likewise  good  food;  there  are  all  sorts  of  laws  and  ordinances  covering  the 
matter  of  good  and  bad  food.  As  to  insects  we  know  that  many  common 
household  pests  are  absent  from  clean  homes.  When  Mrs.  Carlyle  re- 
moved to  London  the  first  thing  she  did  was  to  look  for  bedbugs.  Today 
we  have  advanced  so  far  that  we  "swat  the  fly"  and  other  common  house- 
hold pests.  Some  insects  like  some  weeds  flourish  only  in  neglected  homes 
and  communities. 

Although  in  recent  years  the  importance  of  good  air,  both  in  prevent- 
ing and  curing  consumption,  has  become  well  known,  yet  the  role  of  bad 
air  in  common  affections  is  scarcely  realized.  Catarrh,  dyspepsia,  and 
nervous  prostration  flourish  in  communities  where  air  conditions  are  neg- 
lected. These  affections,  one  can  not  speak  of  them  as  definite  diseases, 
flourish  like  common  weeds.  They  are  readily  eradicable  by  a  combined 
effort. 

When  a  new  country  is  first  settled  the  old  weeds  of  civilization  arc 
absent :  they  come  in  gradually.  When  the  Kankakee  swamps  were 
drained  and  crops  planted,  farming  was  easy  the  first  year;  there  were 
no  weeds  to  contend  with,  but  in  a  year  or  two  they  began  to  come  in  and 
after  a  few  years  they  were  so  common  that  farming  now  is  mainly  a 
battle  against  weeds.  It  requires  a  combined  effort  among  farmers  to 
keep  them  at  a  minimum.  The  rented  farm,  like  the  rented  home,  is  apt 
to  fall  into  neglect;  it  will  ripen  seed  enough  to  infest  or  infect  the  whole 
country  around.  In  crowded  tenements  life  is  a  constant  battling  against 
ill  health  and  sickness  and  disease.  One  scarcely  realizes  to  what  extent 
poverty  itself  is  dependent  on  chronic  ill  health. 


WEEDS  AND  DISEASES. 

The  analogy  of  the  introduction  and  spread  of  weeds  and  of 
diseases  is  very  interesting  to  me,  because  long  before  I  became  a 
physician  I  had  become  interested  in  the  appearance  of  new  weeds. 
I  have  kept  track  of  new-  arrivals,  particularly  along  rivers  and 
railways  and  in  waste  places.  New  plants  are  brought  in  in  various 
ways.  In  order  to  know  what  is  new  one  of  course  must  know  what 
is  old.  In  time  I  found  plants  that  had  not  been  reported  by 
others;  such  are  said  to  be  "new  to  the  State."     The  botanist 


SPECIFIC  DISEASES.  301 

Usually  gathers  plants  while  travelling,  and  then  he  begins  to  re- 
alize that  many  of  the  weeds  of  other  countries  are  likely  to  appear 
in  his  own  home.  I  have  seen  many  weeds  appear  in  this  State 
that  are  foreigners,  they  are  just  as  foreign  as  the  White  Man  or 
Negro  or  Chinese,  as  foreign  as  the  specific  diseases  just  mentioned, 
but  many  soon  become  thoroughly  acclimated  or  naturalized.1 

When  I  became  a  physician  I  had  a  very  natural  desire  to  have 
a  specimen  of  every  disease  found  in  the  State,  the  " specimen"  to 
consist  either  of  a  bit  of  tissue  or  the  active  cause  (a  microbe  or 
parasite  of  some  kind),  a  photograph  or  merely  "notes  on  cases," 
in  other  words  case  reports.  In  the  course  of  time  I  found  a  few 
diseases  that  had  not  been  reported  previously,  they  were  new  to 
the  State. 

The  student  of  natural  history  and  especially  of  botany  soon 
learns  that  species  vary,  that  there  are  no  sharp  dividing  lines. 
The  student  of  medicine  too  soon  learns  that  there  are  no  hard  and 
fast  lines  in  the  case  of  many  diseases  and  particularly  in  condi- 
tions of  ill  health. 

When  I  first  began  to  botanize  I  asked  friends  who  went  away 
to  send  or  bring  me  plants;  many  promised  but  few  did  so,  and 
then  often  it  was  just  a  flower  and  not  a  "specimen"  such  as  a 
botanist  would  collect.  One  may  be  wholly  unable  to  identify  an 
imperfect  specimen.  One  soon  avoids  asking  friends  to  collect  un- 
less they  happen  to  be  experienced,  and  that  is  also  true  of  "case 
reports." 

1  A  botanist  may  go  mijea  out  of  his  way  in  order  to  study  a  new  weed,  and  after  properly  identi- 
fying it  he  may  make  an  effort  to  destroy  a  patch;  but  after  a  plant  has  become  common  he  scarcely 
notices  it  and  any  effort  to  eradicate  it  would  prove  futile.  The  task  of  ridding  a  locality  of  weeds 
belongs  to  the  community,  a  fact  recognized  by  our  State  laws,  which  require  the  annual  cutting  of 
weeds. 

The  physician  interested  in  the  advent  of  new  diseases  may  likewise  make  great  efforts  to  study 
the  first  cases  but  after  a  disease  becomes  common  he  may  become  indifferent.  Disease  eradication 
must  also  be  done  by  the  community. 


IX. 

BIOGRAPHY  AND  ILL  HEALTH. 


While  in  college  I  was  in  a  class  in  Evolution.  One  term  we 
read  the  Life  and  Letters  of  Charles  Darwin,  which  had  just  ap- 
peared. I  had  already  decided  to  become  a  physician  and  naturally 
1  noticed  references  to  ill  health.  There  were  many  references,  and 
I  wondered  what  it  all  meant.  But  the  subject  of  ill  health  is  not 
a  college  study  and  nothing  was  said  about  it  in  class.  That  was 
really  the  first  time  1  noticed  how  the  subject  of  ill  health  crops 
out  in  biographies  and  in  letters. 

A  few  years  later  while  physician  in  a  hospital  for  insane  I  be- 
came interested  in  letters  written  by  the  insane.  I  encouraged 
patients  to  write,  indeed  I  aimed  to  get  a  specimen  of  the  writing 
of  every  patient  (several  hundred)  under  my  care.  Those  who  had 
no  friends  I  encouraged  to  write  to  me ;  a  few  wrote  regularly  every 
Sunday.  In  the  course  of  years  I  accumulated  a  collection  of  hun- 
dreds of  letters.  1  tried  to  get  autobiographies,  but  with  few  ex- 
ceptions failed.  The  reason  is  simple:  Men  who  are  sent  to  state 
institutions  are  not  likely  to  be  writers.  But  I  did  obtain  several. 
One  was  long  enough  to  make  a  fair  sized  book.  The  man  was  a 
fluent  writer  and  his  frankness  reminded  one  of  old  time  biogra- 
phies ;  he  spoke  about  his  life  as  sane  men  nowadays  are  not  apt  to 
speak. 

Since  I  have  made  a  special  study  of  ill  health,  particularly  of 
old  chronics,  I  have  been  interested  in  getting  biographies  and  in 
comparing  such  accounts  with  printed  biographies  of  people  who 
have  had  much  ill  health,  as  in  the  case  of  Darwin  just  referred  to. 
To  what  extent  can  one  compare  and  draw  conclusions?  To  what 
extent  can  one  interpret  the  "Lives"  of  the  dead  by  the  lives  of 
the  living?     Again,  to  what  extent  can  the  living  profit  by  the 

(302) 


BIOGRAPHY   AND  ILL   HEALTH.  303 

"Lives"  of  the  dead?  In  all  probability  the  best  students  of  the 
biographies  of  people  who  had  much  ill  health  are  people  who  them- 
selves have  ill  health. 

Autobiographies.  A  number  of  my  patients  have  given  me 
autobiographical  accounts,  but  it  should  be  kept  in  mind  that  in  a 
small  community  there  are  few  people  who  are  writers  or  who  lead 
eventful  lives  and  one  may  hesitate  to  cite  them  at  all. 

In  a  general  way  it  may  be  said  that  patients  can  be  divided 
into  two  groups,  those  who  work  with  their  hands  and  those  who 
work  with  their  brains.  Now  poor  people  as  a  rule  work  as  long 
as  they  possibly  can,  until  actually  disabled  by  disease.  They  have 
no  time  to  rest,  to  give  nature  a  chance  to  correct  the  impending 
difficulty.  They  may  not  even  listen  to  advice  regarding  proper 
food,  proper  housing  and  proper  ventilation.  Many  are  as  willing 
to  take  medicine  as  they  are  unwilling,  because  unable,  to  follow 
good  advice.  Some  take  medicine  from  anybody,  including  the 
patent  medicine  men.  In  contrast  to  this  class  are  those  who  in 
the  old  world  are  known  as  the  "better  class,"  but  with  us  there 
are  no  sharp  lines. 

It  is  not  difficult  to  get  data  regarding  the  influence  of  bad  air, 
they  are  mainly  of  the  simple  annals  of  the  poor.  But  it  is  difficult 
to  get  continuous  data  regarding  the  influence  of  good  air.  If  a 
physician  insists  on  his  good  air  advice  being  followed  some  men 
will  change  doctors  rather  than  their  occupation.  That  means  few 
pure  air  biographies  of  men. 

On  the  other  hand  are  the  women.  Those  living  in  the  suburbs 
may  not  be  compelled  to  go  down  town  daily  and  expose  themselves 
to  bad  air.  They  are  better  able  to  live  up  to  good  air  advice.  For 
this  reason  most  of  my  autobiographies  and  biographies  are  from 
women,  a  fact  which  the  reader  may  have  noticed  from  case  reports 
already  cited. 

Today  I  am  inclined  to  ask  every  new  applicant  for  a  brief 
autobiography,  one  saves  much  time  thereby.  Moreover  the  appli- 
cant for  professional  services  is  enabled  to  collect  his  thoughts  and 
to  present  them  systematically  and  to  the  point.     One  soon  finds 


304  DUSTY   AIR   AND   ILL   HEALTtt. 

that  some  long-winded  patients  are  not  worth  while  but  the  very 
fact  that  an  individual  is  willing  to  write  out  such  an  account 
makes  him  worth  while. 

When  I  Avrote  my  paper  on  Dust,  A  Neglected  Factor  in  111 
Health  I  included  one  case  report  which  was  autobiographic,  as 
follows : 

Case  of  Mr.  C,  as  written  by  himself,  May  16,  3904 : 

"Age  at  this  writing,  24  years. 

"Family :  All  long-lived — no  tuberculosis  as  far  as  can  be  traced. 
Mother  and  mother's  family  both  subject  to  colds  and  nose,  throat  and 
stomach  troubles.  Mother  always  extremely  nervous  and  exhausted  after 
such  attacks.    This  condition  also  occurs  in  subject. 

"First  appearance  of  complaint :  Up  to  about  five  years  of  age  no  in- 
flammations or  cold  troubles  of  any  kind.  Then  a  great  susceptibility, 
always  beginning  in  respiratory  organs  and  canal,  and  ending  in  disturbed 
stomach — and  muscular  exhaustion.     End  in  prolonged  cough. 

"Conditions  when  in  school  and  the  vacation  periods :  Up  to  the  time 
of  starting  to  school  no  evidence  of  these  symptoms ;  after  that  colds  very 
frequent — growing  less  frequent  and  ceasing  during  summer  months  of 
vacation.  Several  vacations  spent  in  country,  where  no  disturbances  oc- 
curred.    Recurrence  of  disturbances  upon  continuing  school  sessions. 

"At  18  years  leaves  school.  Office  work :  At  18  leaves  school  and 
takes  office  position.  At  first  this  position  was  not  confining  and  allowed 
of  one-half  time  in  open  air,  during  which  time  no  great  disturbances  oc- 
curred. Then  work  became  more  confining  and  finally  inside  exclusively. 
Cold  conditions  became  aggravated  immediately.  After  about  two  years 
of  this  work  subject  was  compelled  to  quit  work  entirely  for  over  eighteeu 
months,  during  which  subject  suffered  from  continued  colds,  excessive 
nervousness  and  general  weakness.  This  condition  was  owing  partly  to 
confinement  and  partly  to  overwork.  About  three  months  of  the  last  part 
of  this  eighteen  months  of  enforced  idleness  were  passed  in  the  country. 
Those  three  months  were  more  beneficial  than  anything  else  toward  im- 
proving condition. 

"Occupation  since  18 :  Both  indoor  clerical  work  and  outside  work — 
no  manual  work.  Habits  sedentary,  body  sluggish.  General  condition 
pretty  good  until  increased  application  to  inside  work — then  condition  be- 
came worse.  Overwork  and  confinement  to  quarters  in  which  practically 
no  ventilation  was  possible  finally  produced  same  condition  as  before — 
continued  and  frequent  colds,  followed  by  stomach  disorders  and  nervous 
exhaustion. 


BIOGRAPHY    AND   ILL    HEALTH.  305 

OBSERVATIONS. 

"1.  Office  in  which  subject  was  occupied  (was)  below  level  ground, 
with  no  facilities  for  ventilation  ;  consequently  dust  and  spittle  deposited 
or  blown  into  the  room  was  held,  and  the  air  was  never  more  than  a  slight 
per  cent.  pure.  Whenever  subject's  work  confined  him  to  this  place  con- 
dition became  rapidly  worse. 

"2.  Dust :  It  was  observed  that  on  clear,  sunny  days  condition  very 
much  improved,  but  two  or  three  days  of  dusty  weather  again  produced 
first  nose  and  throat  and  bronchial  irritations,  and  then  stomach  disorder, 
accompanying  or  following  the  cold  condition ;  that  disorder  followed  on 
exposure  to  blowing  dust  or  indoor  confinement  with  impure  air.  When 
at  home  subject  experienced  no  such  disagreeable  sensations  as  in  the 
down-town  districts  and  districts  where  impure  air  was  the  irritant. 

"3.  Railway  trains :  Two  very  severe  colds  can  be  traced  directly  to 
confinement  for  three  hours  or  less  in  railway  coach — in  both  cases  all 
windows  were  closed  and  cars  full  of  people — some  of  whom  spat  upon  the 
floor  frequently. 

"4.  It  has  been  observed  that  overheating  in  impure  air  will  always 
produce  cold  condition. 

"5.  Conditions  always  worse  after  attending  public  gatherings,  meet- 
ings, etc.,  especially  where  the  majority  of  the  people  assembled  are  men. 
At  one  political  meeting  especially,  where  expectoration  was  unusually 
frequent,  inflammation  began  before  subject  even  left  the  room. 

"6.  Subject  was  formerly  told  by  physicians  that  the  nervous  ex- 
haustion was  produced  entirely  by  overwork,  but  it  has  been  observed  that 
this  nervous  condition  invariably  accompanies  a  cold  or  respiratory  or 
alimentary  inflammation. 

"7.  During  the  sweeping  and  after  the  sweeping  in  the  office  where 
dust  has  been  deposited  for  some  time  a  condition  of  cold  occurs,  but  not 
invariably." 

The  above  notes  were  copied  on  the  machine  just  as  they  were 
handed  in. 

I  hope  some  day  this  man  will  write  a  detailed  account  of  his 
life,  especially  dwelling  on  his  observations  since  writing  this  brief 
account.  He  has  learned  to  live  within  his  limitations  and  to  re- 
duce ill  health  to  a  minimum. 

In  this  volume  when  speaking  of  environmental  influences  one 
has  largely  in  mind  the  average  man  or  average  "case"  or  patient. 
At  either  end  are  extremes.  That  environmental  influences  or 
causes  that  produce  symptoms,  ill  health  or  disease,  should  mani- 
fest themselves  differently  in  the  "idle  rich"  and  again  differently 

[201 


306  DUSTY    AIR    AND    ILL    HEALTH. 

in  those  who  are  desperately  poor,  must  be  self-evident.  And  that 
the  very  active  brain  worker  should  have  symptoms  scarcely  known 
to  the  dull  witted  manual  laborer  must  also  be  evident. 

Physical  vs.  Mental  Life.  In  general  it  may  be  said  that 
the  individual  leads  two  kinds  of  lives,  a  physical  and  a  mental; 
in  some  one,  in  some  the  other  predominates.  Some  people  have 
such  a  desperate  struggle  to  make  a  living  that  they  have  little  time 
to  think.     Such  lives  would  naturally  form  dull  biographies. 

Everybody  of  course  thinks  more  or  less.  Some  individuals 
now  and  then  have  a  "rush  of  thoughts."  In  some  the  mind  is  so 
active  that  it  continues  at  night  in  dreams.  An  interesting  ques- 
tion is:  Under  what  conditions  is  the  mind  unusually  active,  or, 
under  what  conditions  is  it  not  active?  Of  the  individual  whose 
mind  is  usually  active  one  may  ask,  Under  what  conditions  is  it  not 
active  ?  While  of  the  person  whose  mind  is  occasionally  very  active 
we  may  ask,  Under  what  conditions  does  this  occur? 

To  what  extent  does  environment  influence  an  individual's  phy- 
sical and  mental  life?  I  have  tried  to  show  in  this  volume  how  it 
influences  health  and  ill  health  and  how  one  factor  stands  out,  Dust. 


CASE  REPORTS  AT  SECOND  HAND. 

The  physician  constantly  hears  of  people  afflicted  with  certain 
diseases  or  of  people  in  ill  health.  His  patients  will  tell  him  of 
this  and  of  that  individual  but  the  data  may  be  so  imperfect  that 
he  is  unable  to  make  a  diagnosis.  The  physician,  unlike  the  botan- 
ist, can  not  go  out  and  collect  specimens;  he  must  wait  until  the 
"specimen  of  disease,"  the  afflicted  individual  applies  to  him.  We 
say  the  patient  selects  the  physician,  not  the  physician  the  patient. 

Although  one  may  be  inclined  to  discredit  the  statements  of 
patients  concerning  the  disease  or  ill  health  of  others,  yet  when 
the  ill  health  is  apparently  similar  one  may  attach  considerable 
importance  to  statements.  We  reason  from  analogy.  If  a  physi- 
cian has  "old  experienced  chronics"  who  are  good  observers  he 


BIOGRAPHY    AND   ILL   HEALTH.  307 

may  be  inclined  to  accept  their  statements  as  true,  and  yet  such 
case  reports  are  "second  hand,"  and  that  is  what  I  have  been  try- 
ing to  avoid  in  citing  cases.  Hence  the  frequent  occurrence  of  the 
pronoun  I,  for  I  am  writing  of  my  own  cases. 

Many  of  my  "experienced  patients"  who  are  well  informed 
on  the  subject  of  dust  influences  will  tell  me  about  people  whom 
they  have  observed,  perhaps  friends  whom  they  frequently  see  and 
whose  ill  health  they  will  interpret  in  the  light  of  their  own.  Old 
patients  often  want  to  send  people  to  me  but  I  may  not  see  my 
way  clear  to  accept  them,  or  on  the  other  hand  the  invalid  or  com- 
plaining one  may  not  deem  it  desirable  to  come  to  me. 

One  of  my  patients,  a  middle-aged  woman,  the  wife  of  a  rail- 
roader, had  been  noticing  how  the  air  of  passenger  trains,  espe- 
cially of  smoking  cars,  affects  passenger  conductors.  Now  it  should 
be  understood  that  well  managed  railroad  companies  are  careful 
how  they  advance  their  men.  They  engage  a  large  number  of  men 
for  the  lower  positions  and  out  of  them  they  successively  advance 
those  they  deem  desirable  or  competent.  Men  begin  as  brakemen 
or  firemen  and  may  advance  successively  to  the  very  highest  po- 
sitions. Now  a  man,  say  a  young  country  man,  may  have  good 
health  as  long  as  he  is  a  brakeman  on  a  freight  train,  he  is  leading 
an  outdoor  life,  but  he  may  complain  greatly  when  transferred  to 
a  passenger  train.  The  man  with  constant  colds  and  catarrh  and 
weeping  nose  and  eyes  is  not  apt  to  be  advanced  to  the  position  of 
passenger  conductor.  On  the  other  hand  a  passenger  conductor 
may  complain  greatly  of  dust  infection  that  does  not  manifest  it- 
self by  such  symptoms.  The  disturbance  may  manifest  itself  by 
a  deranged  alimentary  tract  and  since  this  may  present  no  visible 
signs  the  company  retains  the  man,  may  even  advance  him.  A 
man  with  dyspepsia  may  be  able  to  do  the  work  of  a  passenger 
conductor  but  when  he  is  advanced  to  a  still  higher  position  where 
the  work  is  largely  mental  he  may  complain  of  nervous  symptoms. 
He  may  suffer  from  what  is  called  nervous  prostration.  In  the 
lower  positions  it  is  easy  to  supply  a  substitute  when  a  man  is  dis- 
abled but  with  the  higher  positions  this  may  be  difficult,  so  a  man 


308  DUSTY    AIR   AND   ILL   HEALTH. 

may  fall  back  into  a  lower  position.  It  is  only  the  survival  of  the 
fittest  who  are  able  to  and  do  till  the  higher  positions. 

Now  my  old  patient  at  first  had  had  much  ill  health  and  con- 
sultations were  taken  up  with  a  discussion  of  her  own  conditions 
and  symptoms,  but  in  time  as  there  was  less  complaint  there  was 
developed  a  habit  of  discussing  her  friends.  She  was  loyal  to  her 
friends  and  she  would  talk  over  some  that  she  wanted  to  come  to 
me.  Some  I  saw  my  way  clear  to  accept.  At  one  time  her  loyalty 
to  a  friend  was  greater  than  to  me  and  she  brought  the  woman  and 
I  had  to  prescribe  and  advise  whether  I  wanted  to  or  not.  At  an- 
other time  she  was  very  anxious  that  I  accept  as  a  patient  a  man 
who  had  recently  been  promoted  to  be  a  passenger  conductor,  for 
years  he  had  been  a  freight  conductor.  Immediately  he  began  to 
complain.  Evidently  he  was  wholly  unadapted  to  air  conditions 
found  on  small  passenger  trains  where  the  spitter  is  so  conspicuous. 
I  told  her  I  was  willing  to  accept  him  as  a  patient,  but  when  the 
man  himself  found  that  I  would  likely  advise  a  "change  of  occu- 
pation," as  going  back  to  the  outdoor  life  of  the  freight  train,  he 
concluded  not  to  come.  He  had  been  waiting  for  years  and  years 
for  this  promotion  and  the  idea  of  relinquishing  it  was  not  to  be 
thought  of.  Instead  he  would  try  some  other  physician,  one  who 
would  attempt  to  cure  by  the  use  of  medicine  alone. 

Now  I  never  saw  this  man  and  yet  I  could  give  quite  a  full 
history  from  data  obtained  through  my  patient,  in  weekly  or 
monthly  installments.  We  were  both  interested  in  the  man.  The 
story  as  I  obtained  it  from  my  patient  was  to  me  like  studying  an 
individual  through  his  biography.  The  man  finally  died.  I  feel 
confident  that  had  he  lived  up  to  good  air  advice  he  might  have 
lived  on  indefinitely  instead  of  dying  prematurely  and  leaving  a 
family  of  immature  children.     Cases  like  that  are  tragedies. 

Although  my  patient  was  above  the  average  in  intelligence  and 
was  a  good  observer,  yet  she  was  not  much  of  a  reader.  I  tried  to 
interest  her  in  reading  biographies  of  people  who  had  ill  health. 
My  reasons  were  not  wholly  altruistic,  although  she  would  profit 


BIOGRAPHY   AND   ILL   HEALTH.  309 

by  such  reading  I  myself  would  profit  by  getting  the  references  to 
ill  health. 

One  of  ray  well-informed  patients  was  travelling  on  an  inter- 
urban  car.  At  a  small  town  two  men  took  seats  directly  behind  her 
and  from  remarks  about  the  weather  and  generalities  soon  began  to 
talk  about  health  matters.  One  man  evidently  was  a  well-to-do 
farmer  and  the  other  was  a  county  surveyor,  judging  by  the  con- 
versation they  had  about  road  improvements.  The  farmer  compli- 
mented the  surveyor  on  his  success  in  getting  good  roads  built ;  the 
surveyor  attributed  this  to  the  fact  that  he  was  always  ready  to 
talk  with  people,  even  spending  evenings  at  his  office  at  the  court 
house.  He  tried  to  bring  men  who  opposed  each  other  together  to 
exchange  views,  making  his  office  a  meeting,  or  shall  one  say  a 
loafing?  place.  From  discussion  about  roads  and  weather,  they 
talked  of  their  health  and  then  the  surveyor's  voice  had  a  still  more 
doleful  sound  to  my  patient ;  he  complained  greatly ;  said  he  could 
not  understand  why  he  runs  down  at  the  beginning  of  every  year, 
that  during  the  last  few  years  he  ran  down  worse  than  ever.  My 
patient  gathered  from  the  tone  of  his  voice  even  more  than  from 
his  words  that  the  man  was  much  "run  down"  and  after  telling 
of  the  remedies  and  doctors  he  had  tried,  it  was  evident  that  he 
was  very  much  discouraged.  The  farmer  suggested  that  he  accom- 
pany him  to  California,  that  he  was  going  merely  to  spend  the 
winter.  The  surveyor  wished  he  could,  he  feared  he  might  later 
on  be  compelled  to.  For  the  last  few  years  February  and  March 
had  been  his  worst  months ;  he  felt  that  if  he  could  hold  out  during 
these  months  he  would  get  along  again,  but  he  was  starting  in  so 
early  this  year  with  his  aches  and  pains,  nothing  much  the  matter 
but  "just  have  no  appetite  and  don't  feel  like  bestirring  myself;" 
he  feared  he  would  not  hold  out.  He  told  how  well  he  felt  during 
the  summer  when  out  looking  after  the  construction  of  roads, 
spending  little  time  in  the  court  house. 

My  patient  "understood  the  case  at  once,"  too  much  confine- 
ment about  the  court  house  and  too  much  inhalation  of  court  house 


3]0  DUSTY    AIR    AND   ILL    HEALTH. 

air!  She  almost  felt  it  her  duty  to  turn  around  and  speak  to  the 
man,  but  yet  that  was  not  proper,  she  did  not  know  him  at  all,  and 
besides  she  knew  she  could  not  make  herself  understood;  some 
things  can  not  be  explained  briefly.  When  the  men  were  leaving 
the  car,  she  did  turn  around  to  tret  a  good  look  at  the  sick  man; 
he  was  anemic,  very  pale  and  languid.  My  patient  said  if  my  book 
had  been  out  she  would  have  told  the  man  of  it,  that  it  would  give 
him  the  explanation  of  his  ill  health — I  am  just  vain  enough  to 
think  that  this  book  will  fulfill  my  patient's  expectations. 

Cases  or  " histories  of  ill  health"  of  course  occur  in  infinite 
variety.  It  is  hoped  that  in  this  volume  a  sufficient  number  and 
variety  of  cases  have  been  cited  to  direct  the  reader's  attention  to 
a  neglected  factor  in  ill  health  and  that  he  will  find  at  least  one 
case  that  approximates  his  own,  enabling  him  to  make  a  compar- 
ative study. 

The  reader  should  keep  in  mind  that  my  cases  are  "selected 
cases. ' '  They  are  picked  out  from  a  large  number.  There  may  be 
other  factors  operative  but  here  I  have  emphasized  only  one,  the 
factor  that  is  commonly  neglected.  The  reader  who  wants  case 
reports  that  are  written  impartially,  with  no  theory  to  uphold, 
might  be  referred  to  the  biographies  of  people  who  had  much  ill 
health,  where  references  are  incidental. 

During  the  last  few  years  I  have  been  reading  many  biographies 
of  people  who  had  more  or  less  chronic  ill  health,  mainly  to  de- 
termine to  what  extent  air  conditions  or  dust  influences  crop  out. 
One  frequently  gets  on  the  wrong  track  and  may  do  a  lot  of  read- 
ing only  to  find  in  the  end  that  there  is  nothing  in  it.  Some  biog- 
raphies contain  so  little  mention  of  ill  health  that  one  almost  thinks 
a  mention  of  it  was  not  worth  while,  if  not  a  disgrace.  There  may 
be  so  few  references  to  the  matter  of  health  and  ill  health  that  a 
biography  is  not  worth  while  to  the  student  of  ill  health.  On  the 
other  hand  there  may  be  many  references.  Where  there  are  sev- 
eral volumes  (as  in  the  case  of  Darwin)  one  must  read  carefully 
not  to  miss  any.    Then  again  often  little  things  are  mentioned  that 


BIOGRAPHY   AND   ILL   HEALTH.  311 

at  first  sight  seem  to  have  no  relationship  to  ill  health  but  which 
may  really  be  of  importance. 

Now  individuals  who  have  or  had  much  ill  health  are  apt  to  be 
better  readers  or  students  of  biographies  of  people  who  had  much 
ill  health  than  those  who  are  in  robust  health,  and  it  may  become 
highly  profitable  to  the  physician  to  interest  them  and  to  discuss 
details.  The  physician  in  the  small  community  where  there  are 
few  literary  people,  not  to  mention  poor  library  facilities,  greatly 
appreciates  such  assistance. 

Another  interesting  topic  is  to  get  the  details  of  individuals 
who  report  themselves  cured  by  outlandish  modes  in  weekly  or 
monthly  journals.  Some  cases  as  they  stand  are  reflections  on,  if 
not  an  indictment  of,  the  medical  profession,  and  yet  when  one 
gets  details  it  may  be  anything  but  that.  For  instance,  a  retired 
preacher  in  bad  health  after  trying  the  doctors  and  trying  sana- 
torium treatment  in  vain  adopted  the  faith  cure,  he  was  cured  by 
faith,  so  he  said,  in  a  letter  to  a  religious  weekly.  It  was  not  diffi- 
cult to  get  details  and  then  T  found  the  following  conditions: 

The  old  man  had  been  living  in  a  large  city ;  he  had  been  com- 
plaining more  or  less  and  finally  was  forced  to  give  up.  Physi- 
cians did  not  help  him  much  and  so  when  feeling  unusually  bad, 
in  midwinter,  he  went  to  a  large  sanatorium,  that  meant  to  be  still 
confined  indoors.  Then  at  "darkest  before  dawn"  he  decided  to 
take  up  a  faith  cure,  not  by  changing  his  religion  but  by  relying 
on  its  power  to  cure  the  sick.  He  went  back  to  his  old  country 
home,  a  very  clean  little  town  on  the  high  banks  of  a  river,  and 
here  under  good  air  conditions  he  recovered.  When  I  got  the  de- 
tails I  at  once  saw  that  it  was  not  a  faith  cure  at  all,  it  was  a  na- 
ture cure.  One  can  predict  what  will  happen  when  such  a  man 
goes  back  into  his  old  environment ;  the  student  of  ill  health  thinks 
of  subsequent  events. 

Every  now  and  then  some  patient  calls  my  attention  to  such 
"case  reports."     Substituting  the  name  of  some  drug  or  "new 


312  DUSTY    AIR    AND    ILL    HEALTH. 

remedy"  for  imponderable  faith  or  prayer,  one  sees  similar  case 
reports  in  medical  journals;  dust  influences  may  readily  be  read 
between  the  lines.  But  the  individual,  the  patient,  who  was  cured 
by  change  of  place  or  by  change  in  time  may  relapse.  The  man 
who  is  cured  by  going  to  a  small  town  may  relapse  on  going  back 
to  the  city ;  the  man  who  was  cured  by  a  new  remedy  in  the  spring 
may  relapse  on  the  return  of  the  closed  door  season.  After  study- 
ing a  number  of  cases  I  came  to  the  conclusion  that  "Odd  as  such 
an  expression  may  sound,  I  am  almost  tempted  to  say  that  I  could 
take  the  same  patients  and  'make  them  sick'  on  the  exploited  rem- 
edy— simply  by  beginning  treatment  in  the  summer  and  ending 
in  the  winter  months."  (A  Study  of  Reprints  and  Clinical  Re- 
ports on  Proprietary  Medicines.     Amer.  Med.  June  10,  1905.) 


BIOGRAPHY   AND   ILL   HEALTH.  313 

BIOGRAPHY  AND  THE  INFLUENCE  OF  ENVIRONMENT. 

As  just  mentioned  there  are  many  references  to  ill  health  in 
the  Life  and  Letters  of  Charles  Darwin.  To  what  extent  can  we 
interpret  the  nature  of  a  man's  ill  health  from  his  biography  in 
the  light  of  living  people  who  seem  to  have  similar  ill  health  ?  On 
the  other  hand,  to  what  extent  can  the  living  profit  by  the  "Lives" 
of  the  dead?  This  is  a  subject  that  I  have  brought  up  several 
times  before  learned  societies.1  The  subject  is  a  large  one  and  I 
can  only  refer  to  it  here  very  briefly. 

Biographies  differ  greatly  according  to  the  sort  of  life  a  man 
led,  whether  eventful  or  not.  Uneventful  lives  furnish  dull  biog- 
raphies. The  fact  that  a  man  was  a  statesman,  a  literary  -man,  a 
soldier,  a  musician  or  a  scientist  naturally  colors  the  biography. 
Then  the  abilities  and  limitations  of  the  man  who  writes  the  biog- 
raphy must  be  considered.  As  a  rule  the  biographer's  vocation  is 
similar  to  that  of  the  individual  about  whom  he  writes.  The  Life 
of  a  musician  is  most  apt  to  be  written  by  a  man  who  is  a  musician 
or  has  a  good  knowledge  of  music;  the  Life  of  the  soldier  by  a 
military  man.  The  Life  of  a  scientist,  a  life  of  interest  perhaps  to 
only  a  scientist,  is  apt  to  be  written  by  a  scientist ;  the  same  may  be 
said  of  a  medical  man.  One  expects  the  Life  of  a  literary  man  to 
be  written  by  a  literary  man  and  contain  much  book-chat. 

Now  everybody  is  likely  to  have  more  or  less  ill  health  and 
sickness.  Some  escape  in  youth,  to  suffer  much  toward  the  end. 
To  what  extent  these  things  are  mentioned  in  biographies  is  an  in- 
teresting question.  Some  biographies  have  practically  no  mention ; 
others  are  full  of  references  to  ill  health.  A  biographer  who  has 
robust  health  may  wholly  fail  to  make  mention  of  ill  health,  while 
on  the  other  hand  the  biographer  who  himself  has  more  or  less  ill 
health  may  make  frequent  mention.  (Practically  speaking,  there 
are  no  biographies  that  deal  with  a  man's  ill  health  as  books  now 

1  The  Chronic  111  Health  of  Darwin,  Huxley,  Spencer,  and  George  Eliot,  Indiana  Academy  of 
Science,  1905. 

Benjamin  Franklin's  Observations  on  Colds  and  111  Health,  Cass  County  (Ind.)  Medical  Society, 
1906. 

Biography  and  the  Influence  of  Environment,  Indiana  Academy  of  Science,  1908. 

The  Chronic  111  Health  of  Charles  Darwin,  Amer.  Ass'n  Advct.  Science,  Boston,  1909. 

Charles  Dickens  and  Sanitation.    Cass  Co.  (Ind.)  Med.  So.  Feb.,  1912. 


314  DUSTY    AIR   AND    ILL    HEALTH. 

deal  with  his  statesmanship,  military  exploits,  his  books,  his  con- 
tributions to  science,  etc.  At  least  I  know  of  none ;  I  am  speaking 
of  ill  health  dependent  on  the  influence  of  environment.  It  must 
be  evident  that,  a  ''medical  biography"  which  brings  in  a  mass  of 
facts  relating  to  some  definite  disease  may  not  be  of  great  value  to 
the  student  of  common  ill  health,  particularly  if  the  writer  is 
biased. ) 

The  student  of  dust  influences  must  of  course  constantly  keep 
in  mind  the  occupation  of  the  individual  about  whom  he  is  read- 
ing and  the  environment  under  which  he  lived.  We  all  have  an 
idea  under  what  conditions  a  statesman  spends  his  life  and  all  have 
an  idea  of  the  surroundings  of  the  literary  man.  But  merely  to 
say  that  an  individual  is  a  statesman  or  a  literary  man  is  not  suffi- 
cient. We  must,  for  instance,  sharply  distinguish  between  poets 
and  novelists  and  historians.  All  may  be  regarded  as  "book- 
worms, ' '  men  who  consult  books  more  or  less  freely.  The  historian 
must  dig  out  his  data  from  old  dusty  and  musty  tomes.  He  may 
or  must  visit  the  country  and  the  scenes  he  is  about  to  describe, 
but  the  life  out  of  doors  is  apt  to  be  short  compared  to  the  time 
spent,  in  dusty  libraries.  A  novelist  may  spin  a  story  offhand,  a 
problem  novelist  may  have  to  read  much,  or  he  may  spend  much 
time  among  people  getting  firsthand  information ;  after  getting  his 
data,  he  may  go  into  seclusion  to  write.  Tn  general  similar  remarks 
apply  to  the  poet.  A  poet  like  Milton,  whose  works  are  full  of 
classical  allusions,  must  have  read  much ;  on  the  other  hand,  Words- 
worth's writings  are  about  things  he  saw  in  the  country:  We  speak 
of  certain  poets  as  city  poets,  they  describe  crowded  streets ;  others 
as  poets  of  the  country,  they  tell  of  the  simple  life,  of  the  open 
sky  and  fresh  air.  Offhand  one  would  be  inclined  to  assume  that 
the  latter  are  long-lived. 

Indiana  Biographies.  There  are  few  Indianians  whose  lives 
have  been  written  up  in  detail  and  references  to  ill  health  are 
mainly  incidental.  Where  there  was  much  ill  health  some  mention 
can  not  be  avoided.  It  is  to  be  hoped  that  some  one  who  has  ac- 
cess to  data  will  write  a  biography  taking  up  in  detail  the  ill 


BIOGRAPHY   AND   ILL   HEALTH.  315 

health,  say  of  Governor  0.  P.  Morton.  There  is  already  an  ex- 
cellent general  biography  but  there  are  not  enough  details  to  en- 
able the  student  of  ill  health  to  arrive  at  satisfactory  conclusions. 

Governor  Morton  was  a  country  boy  who  on  going  to  the  city  held 
out  very  well  at  first  but  in  time  symptoms  of  ill  health  appeared. 
He  spent  much  time  in  the  State  House;  gradually  symptoms  as- 
cribable  to  environmental  influences  began  to  appear.  Moreover 
making  political  speeches  in  crowded  halls  where  spitters  abound 
is  a  hazardous  occupation.  There  is  mention  that  "his  father  was 
a  paralytic  in  his  latter  years  and  an  aunt  had  been  similarly 
stricken."  When  Governor  Morton  became  paralyzed  in  the  lower 
extremities  he  believed  his  hour  had  come.  Evidently  he  had  a 
high  blood  pressure.  His  physicians  prescribed  absolute  rest,  but 
as  soon  as  he  had  partially  recovered  he  was  back  at  work.  Evi- 
dences of  the  paralysis  remained  and  finally  he  went  to  Paris  to 
consult  a  famous  specialist,  but  he  apparently  got  more  benefit 
from  the  rest  and  the  outing  (he  returned  by  way  of  Switzerland) 
than  from  the  medical  treatment,  a  mode  of  treatment  that  is  now 
considered  barbarous. 

After  being  governor  he  became  a  senator  and  that  again  meant 
indoor  life  in  crowds.  At  times  of  an  election  he  made  public 
speeches.  There  were  ups  and  downs.  One  can  clearly  see  how  a 
prolonged  rest  benefited  him  and  how  severe  exposure  to  bad  air 
aggravated.  He  died,  evidently  on  account  of  a  high  blood  pres- 
sure, still  comparatively  young. 

New  England  Biographies.  The  most  popular  and  generally 
accessible  biography  of  Americans  are  those  of  New  England  lit- 
erary people.  (Those  who  question  such  a  statement  will  naturally 
ask  what  sort  of  library  facilities  a  man  has.)  In  some  biographies 
environmental  influences  can  be  traced  fairly  well.  New  England 
biographies  moreover  have  an  advantage  from  the  fact  that  there 
was  more  or  less  visiting  and  correspondence  and  one  gets  many 
cross  references.  Thus  there  may  be  mention  of  an  acute  attack 
of  ill  health  but  no  clew  regarding  antecedents,  the  clew  being 
found  in  some  other  biography.    It  is  interesting  to  trace  out  fac- 


31 6  DUSTY    AIR    AND    ILL    HEALTH. 

tors  concerned  in  ill  health,  but  it  requires  much  time  and  good 
library  facilities  or  a  long  purse  to  buy  all  biographies — It  is  not 
advisable  for  dust  victims  to  use  old  library  books. 

Louise  M.  Alcott  was  a  story  writer  more  or  less  dependent  on 
moods.  We  must  make  distinctions  between  getting  the  plot  of  a 
story  and  the  best  conditions  for  writing  it.  It  would  be  interest- 
ing to  know  why  writers  are  dependent  on  moods,  why  they  can 
write  well  one  day  or  one  week  and  not  at  all  the  next,  or  in  one 
place  and  not  in  another.  Under  what  conditions  does  a  writer 
complain  of  being  unable  to  write  ?  When  a  man  is  unable  to  work 
we  say  he  is  sick.  What  shall  be  said  of  the  literary  man  unable 
to  work?    Shall  we  say  he  too  is  sick,  mentally  ill? 

From  the  biography  of  Louisa  M.  Alcott  (Cheney)  it  appears 
that  she  had  good  health  up  to  the  time  she  became  a  nurse  at 
Washington,  on  the  outbreak  of  the  Civil  War.  Here  under  hor- 
ribly bad  air  conditions  she  was  stricken  with  an  acute  fever  and 
lost  her  immunity  to  bad  air.  She  complained  of  various  symp- 
toms, including  at  times  an  inability  to  write.  Periodically  she 
would  break  down  and  go  to  Europe.  She  would  begin  to  feel 
better  on  board  ship  and  felt  well  while  in  Europe,  but  we  find 
her  complaining  of  her  old  ills  as  soon  as  she  returned  home.  City 
and  country  exercised  an  influence.  One  can  clearly  see  that  her 
ill  health  was  dependent  on  environmental  influences.  Naturally 
she  made  the  rounds  of  the  doctors.  At  one  time  she  expressed 
her  belief  that  after  having  had  nine  doctors  she  had  found  the 
right  one,  but  there  was  no  cure  for  her.  She  died  prematurely. 
A  number  of  my  patients  have  read  her  biography  and  all  believe 
she  must  have  been  a  dust  victim. 

J.  G.  Whittier  is  commonly  regarded  as  a  poet  although  he 
wrote  much  prose,  especially  in  his  younger  days.  For  years  he 
was  connected  with  newspapers.  He  was  a  country  boy,  not 
adapted  to  city  life,  a  fact  which  he  himself  soon  discovered  and 
then  sought  isolation.  In  addition  to  his  other  difficulties  he  had 
defective  vision,  a  common  affliction  in  dust  victims  on  account  of 


BIOGRAPHY   AND   ILL   HEALTH.  317 

the  nearness  of  the  eyes  to  the  nose  and  air  passages,  where  infec- 
tion is  constantly  passing.  Whittier's  ill  health  has  heen  explained 
as  being  due  to  "eyestrain"  but  we  must  go  further  and  inquire 
why  eyestrain  is  so  common  in  certain  individuals  and  under  cer- 
tain surroundings.  We  may  come  to  the  conclusion  that  eyestrain 
is  one  of  the  penalties  of  living  under  unsanitary  surroundings. 

W.  H.  Prescott.  Prescott  was  a  historian;  he  had  to  obtain 
his  data  from  books,  especially  from  old  books  and  old  manu- 
scripts. His  ill  health  began  early  and  throughout  his  life  there 
was  much  of  it.  At  times  he  would  suffer  severely  and  then  again 
largely  escape,  depending  on  the  surroundings  or  conditions  under 
which  he  lived. 

Here  I  shall  not  attempt  to  go  into  details.  I  am  merely  mak- 
ing general  mention  in  the  hope  of  directing  the  reader's  attention 
to  some  biographies  that  he  may  read  with  profit. 

English  Biographies.  In  general  it  may  be  said  that  English 
biographies  are  more  satisfactory  to  the  student  of  ill  health  than 
our  own,  for  several  reasons :  First,  English  writers  as  a  rule  live 
in  London  (West  End)  and  frequently  visit  each  other  and  that 
means  there  are  many  cross  references.  Second,  because  London- 
ers are  alive  to  the  question  of  good  air  and  change  of  air  and 
change  of  climate.  Now  it  should  be  kept  in  mind  that  the  west 
end  of  London  is  comparatively  thinly  built  up,  it  has  many  large 
parks.  The  wind  usually  comes  from  across  Windsor  Forest  and 
the  open  country.  The  exceptional  East  Wind  brings  the  smoke 
and  dust  from  the  heart  of  the  city,  particularly  from  the  East 
Side  where  the  poor  are  densely  massed,  and  then  there  is  apt  to 
be  complaint,  especially  by  those  who  are  very  susceptible  to  dust 
influences.  Mrs.  Browning,  for  instance,  frequently  complained 
of  the  East  Wind. 

Mrs.  E.  B.  Browning  was  country  bred  and  had  much  ill  health 
while  in  London  but  her  health  at  once  improved  on  living  under 
good  air  conditions  in  Italy.  In  wrarmer  countries  people  live  more 
out  of  doors  than  in  cold  northern  ones.    Now  and  then  she  vis- 


318  DU8TY    AIR    AND   ILL   HEALTH. 

ited  her  old  home  but  would  at  once  complain  and  usually  shorten 
her  visits.  She  blamed  the  climate,  not  knowing  what  the  real  fac- 
tors were  and  that  much  of  her  ill  health  was  preventable  and 
that  she  could  have  lived  in  rural  England  perhaps  just  as  well 
as  in  Italy  had  she  known  her  limitations.  She  frequently  men- 
tioned the  Tramontana  while  living  in  Florence.  This  is  a  wind 
coming  from  the  Apennines;  it  also  is  an  east  wind.  One  would 
assume  that  a  mountain  wind  brings  health  but  we  should  not  for- 
get that  when  it  reaches  the  city  it  brings  the  filth  of  the  city  on 
to  people  who  live  in  the  opposite  end. 

Thomas  Carlyle  was  a  country  Scotchman  living  in  London. 
He  had  life-long  ill  health.  He  is  commonly  regarded  as  a  dys- 
peptic and  hypochondriac,  but  if  we  carefully  study  his  biography, 
including  cross  references  in  other  biographies,  we  may  arrive  at 
the  conclusion  that  he  was  a  dust  victim.  The  same  remarks  apply 
to  his  wife,  who  also  came  from  rural  Scotland.  She  realized  that 
although  her  health  was  bad  in  London  she  had  good  health  on 
visiting  her  old  home  in  the  country.  But  in  the  country  she  had 
nobody  to  talk  to.  She  preferred  to  live  in  the  city  where  she  met 
people;  she  preferred  congenial  people  and  poor  health  to  good 
health  in  the  country  but  no  one  to  talk  to.  She  was  not  excep- 
tional. The  physician  constantly  meets  people,  especially  women, 
who  say  they  would  rather  be  dead  than  move  or  remove  to  the 
country. 

One  hardly  expects  a  man  of  Carlyle 's  cast  of  mind  to  talk 
about  his  ailments,  and  yet  his  biography  and  his  letters  are  full 
of  references  to  his  chronic  ill  health. 

George  Eliot  was  one  of  the  foremost  women  writers;  her 
novels  are  based  on  a  study  of  human  nature.  She  had  frequent 
discussions  with  Herbert  Spencer,  England's  foremost  philosopher. 
One  might  think  the  subject  of  common  ill  health  and  the  detailing 
of  symptoms  were  beneath  her  dignity  and  yet  her  biography,  that 
is  the  letters  printed  in  her  biography,  are  full  of  such  references. 
The  explanation  is  perhaps  simple :  Many  of  her  letters  are  to  old 


BIOGRAPHY   AND   ILL   HEALTH.  319 

friends,  people  who  moved  on  an  entirely  different  plane.  There 
were  few  points  of  contact,  but  there  is  one  that  is  almost  universal ; 
just  as  people  in  health  speak  of  the  weather,  those  in  ill  health 
speak  of  their  complaints.  Her  friends  wrote  about  their  ills  and 
she  did  the  same.  Her  letters  give  a  fair  account  of  her  health 
and  her  symptoms  and  of  course  more  or  less  of  conditions  under 
which  she  lived.  Although  letters  are  given  in  chronological  order, 
yet  the  data  may  not  be  in  the  same  order,  for  a  letter  may  refer 
to  events  of  months  or  even  to  years  ago.  Such  references  should 
be  properly  placed.  George  Eliot's  biography  is  perhaps  one  of 
the  simplest  and  most  satisfactory  to  the  student  of  ill  health 

Charles  Darwin.  In  the  case  of  George  Eliot  there  is  really 
only  one  volume  of  biography,  that  by  her  husband.  Although 
there  are  several  other  volumes  treating  of  her  life  and  personality, 
they  contain  very  little  information  of  value  to  the  student  of  ill 
health;  they  can  scarcely  be  considered  as  supplementary  and  the 
general  reader  can  dispense  with  them.  In  the  case  of  Darwin 
there  are  four  volumes,  two  appeared  years  after  the  others.  There 
is  of  course  an  immense  literature  relating  to  Darwinism.  George 
Eliot's  biography  is  chronological;  Darwin's  biography  on  the 
other  hand  is  largely  topical,  that  is  letters  relating  to  certain 
topics  are  brought  together.  To  bring  all  the  data  in  chronological 
order  is  quite  a  task,  how  large  I  did  not  realize  until  I  came  to 
copy  out  the  references  to  ill  health  and  environmental  influences 
for  a  paper  at  the  time  of  his  hundredth  anniversary.  Darwin 
was  a  marked  dust  victim,  but,  from  the  fact  that  he  had  much 
ill  health  while  living  in  the  isolated  country,  his  complaints  seem 
rather  puzzling,  until  one  considers  that  he  got  whole  cartloads 
of  old  books  from  the  city,  and  that  when  too  ill  to  be  about  he 
would  look  them  over  reclining  on  a  couch ;  that  meant  literally  to 
get  ' ' filled  up  on  city  dust."  He  mentions  abstracting  whole 
series  of  Transactions  of  learned  societies.  He  realized  that  books 
were  dusty  and  that  one  gets  dirty  handling  them,  indeed  he  wrote 
a  paper  on  the  importance  of  having  cut  edges  and  gilt  tops.  But 
that  his  ill  health  was  dependent  on  dust  influences  he  did  not  at 


320  DUSTY   AIR   AND   ILL   HEALTH. 

all  realize.    His  life  history  is  a  very  interesting  one  to  the  student 
of  chronic  ill  health. 

Darwin  had  much  faith  in  hydropathy  and  frequently  went  to 
a  water  cure  establishment.  With  all  his  knowledge  about  animate 
nature  he  evidently  did  not  properly  understand  the  relationship 
of  cause  and  effect,  he  did  not  study  nor  understand  the  factors 
that  produce  ill  health  or  restore  health.  Scientists  as  a  rule  have 
a  great  knowledge  along  certain  lines  only,  along  others  they  may 
possess  the  knowledge  of  the  average  man  or  that  which  they  have 
perhaps  imbibed  at  home  from  ignorant  parents.  But  in  the  case 
of  Darwin  we  should  not  forget  that  he  was  the  son  and  grandson 
of  physicians,  and  that  his  knowledge  regarding  matters  relating 
to  health  and  ill  health  and  disease  was  far  above  the  average.  In- 
deed, he  went  to  medical  college  for  a  time;  his  father  wanted  him 
to  be  a  physician,  but  the  practice  of  medicine  had  little  attraction 
for  him,  as  for  many  another  man  of  a  scientific  cast  of  mind,  Hux- 
ley, for  instance.  The  humdrum  life  of  the  average  practitioner 
of  medicine  does  not  appeal  to  such  men;  moreover,  they  are  usu- 
ally not  believers  in  the  free  use  of  drugs.  At  that  time  so-called 
laboratory  work  was  unknown,  if  we  except  dissections.  Darwin 
himself  revolutionized  the  study  of  medicine,  which  is  really  a 
branch  of  biology. 

Among  my  scientific  friends  are  several  men  who  have  medical 
degrees  but  who  soon  became  dissatisfied  with  the  practice  of  med- 
icine and  instead  took  up  teaching ;  to  be  in  competition  with  a  lot 
of  symptom-prescribers  was  distasteful.  More  than  one  has  told 
me  that  the  study  of  ill  health  and  perhaps  disease  in  the  light  of 
environmental  influences  appealed  to  him.  Indeed,  one  man  al- 
most decided  to  take  up  practice  again,  after  a  "little  brushing 
up,"  but  when  I  explained  to  him  the  difficulties  one  encounters, 
especially  how  one  must  swallow  his  pride  in  dealing  with  disagree- 
able people  and  always  be  on  the  lookout  to  earn  enough  to  make 
a  living,  he  abandoned  the  idea. 

Medicine  is  too  often  considered  in  the  light  of  a  science,  and 
the  physician  as  a  scientist.    The  science  of  medicine  is  of  course 


BIOGRAPHY    AND    ILL    HEALTH.  321 

based  on  many  sciences.  The  practice  of  medicine  however  is  an 
art  based  on  other  arts.  We  need  only  consider  the  art  of  pleas- 
ing people,  such  as  the  "disagreeable  dyspeptic"  and  the  "sharp- 
tongued  neurotic."  The  man  who  practices  purely  as  a  scientist 
and  the  man  who  practices  without  a  knowledge  of  science  are  both 
out  of  their  element. 

The  biographies  of  three  Englishmen  who  visited  our  country 
are  of  especial  interest,  those  of  Charles  Dickens,  Thomas  II .  Hux- 
ley, and  Herbert  Spencer.  All  three  men  were  dust  victims  and 
suffered  more  or  less  severely  while  here.  They  suffered  in  pro- 
portion as  they  were  exposed  to  "crowd  poison."  The  explanation 
is  perhaps  not  far  to  seek  but  to  explain  it  briefly  is  a  difficult 
matter. 

Charles  Dickens  was  the  son  of  a  poor  government  clerk  and 
at  first  had  a  hard  struggle  for  existence.  Perhaps  this  is  the  rea- 
son he  was  always  in  sympathy  with  the  poor.  He  was  early  ap- 
prenticed to  a  shoe-blacking  manufacturer  at  starvation  wages  and 
was  habitually  in  want  of  sufficient  and  proper  food.  After  addi- 
tional schooling  he  learned  stenography  and  became  a  court  re- 
porter and  finally  a  newspaper  reporter.  Then  he  began  to  write 
fiction.  The  "Pickwick  Papers"  at  once  made  him  famous,  and 
his  days  of  poverty  were  at  an  end.  "David  Copperfield"  is  said 
to  be  mainly  autobiographical.  At  the  age  of  thirty  he  made  a 
visit  to  our  country,  no  doubt  to  broaden  his  horizon.  His  '  •  Amer- 
ican Notes ' '  and  parts  of  his  ' '  Martin  Chuzzlewit ' '  were  the  result 
of  this  trip. 

Charles  Dickens  made  two  visits  to  our  country,  one  in  1842, 
as  a  young  man,  and  one  twenty-five  years  later,  at  the  age  of 
fifty-five.  If  I  were  to  characterize  these  two  trips,  according  to 
his  American  Notes  and  according  to  Forster's  biography,  and  the 
volume  of  letters,  I  would  say  that  the  first  trip  is  remarkable  on 
account  of  the  many  references  to  our  national  tobacco  chewing 
and  spitting  habit,  and  the  second  on  account  of  the  numerous 
references  to  ill  health ;  he  was  constantly  on  the  point  of  breaking 
down,  and  indeed  shortened  his  tour  to  get  back  home.    His  read- 

[211 


322  DUSTY   AIR   AND   ILL   HEALTH. 

ing  tours  had  serious  consequences ;  they  undoubtedly  hastened  his 
death. 

When  Dickens  first  came  to  us  he  expected  to  find  a  free  country, 
.1  free  people.  He  expected  more  real  liberty  than  in  England. 
In  this  he  was  disappointed.  He  found  that  many  people  were  held 
in  slavery  (the  negroes),  and  that  others  were  subdued  by  public 
opinion  (or  shall  we  say  newspaper  opinion?)  ;  that  many  did  not 
dare  to  speak  out  openly — a  fact  impressed  upon  us  today:  Boost, 
Don't  Knock.  He  saw  that  we  were  too  contented  with  ourselves 
and  made  no  radical  effort  to  better  conditions. 

On  his  first  tour  Dickens  was  litlle  confined  indoors,  in  fact  he 
travelled  mainly  during  the  open  door  season,  and  chiefly  by  stage 
coach  and  canal  and  river  boat,  and,  being  a  vigorous  young  man 
fond  of  outdoor  exercise,  he  escaped  ill  health ;  at  least  there  is  no 
mention  in  his  biography. 

Dickens's  second  American  tour  is  of  interest  to  the  physician, 
to  the  student  of  common  ill  health,  on  account  of  the  many  refer- 
ences to  ill  health ;  they  occur  on  almost  every  page. 

In  the  very  beginning  he  was  attacked  by  colds  and  "American 
Catarrh. ' '  The  latter  is  eminently  an  indoor  affection,  transmitted 
from  one  to  another  through  the  medium  of  pulverized  catarrhal 
sputum.  The  biography  and  letters  speak  of  overwork  but  really 
there  was  less  work  and  less  worry  than  there  had  been  in  England. 
Everything  was  planned  and  arranged  for  him ;  he  merely  appeared 
on  the  stage  for  an  hour  and  a  half  or  two  hours  and  then  his  work 
was  over.  But  there  was  overwork.  The  defences  of  the  body  in 
getting  rid  of  infection  were  overworked.  He  was  constantly  in- 
haling infected  dust  and  reacted  acutely,  frequently  being  on  the 
point  of  breaking  down.  The  spitters  no  doubt  were  absent  from 
his  audience  but  they  had  been  there  the  evening  before. 
Then  too  we  must  consider  the  handkerchiefs  that  are  shaken  out, 
particularly  in  saluting  such  a  man.  One  can  see  that  besides  be- 
ing afflicted  with  American  Catarrh,  Dickens  also  had  American 
Dyspepsia  and  was  always  on  the  verge  of  American  Nervous  Pros- 
tration. 


BIOGRAPHY   AND   ILL  HEALTH.  323 

Dickens  had  planned  to  come  as  far  west  as  Chicago  hut  did 
not  get  further  than  Buffalo.  Had  he  come,  for  instance,  into  the 
heart  of  the  spitter's  country  he  likely  would  have  shared  the  fate 
of  his  son.  who  recently  died  shortly  after  a  visit  to  the  Middle 
West,  where  he  lectured  before  a  large  audience  in  a  poorly  ven- 
tilated hall.1  Charles  Dickens  shortened  his  visit  for  fear  of  a 
total  collapse.  He  felt  that  the  only  way  to  get  rid  of  his  Ameri- 
can Catarrh,  and  other  ills  or  symptoms,  was  to  leave  the  country. 
In  this  he  was  not  disappointed,  for  he  tells  of  his  catarrh  begin- 
ning to  leave  soon  after  getting  out  on  the  ocean.  Any  one  can 
understand  that  ocean  air  means  good  air. 

Dickens  had  early  noticed  the  influence  of  environment,  and 
when  things  did  not  go  well  with  him  he  took  a  long  walk  into  the 
country.  One  of  his  biographers  mentioned  the  fact  that  Dickens 
had  a  theory  that,  "To  every  portion  of  the  day  given  to  labor 
should  correspond  an  equal  number  of  hours  spent  in  walking." 
He  mentioned  that  his  best  loved  wralks  were  on  the  cliffs  and  across 
the  downs  by  the  sea  and  that  he  had  remarkable  powers  of  endur- 
ance as  a  pedestrian.  We  see  this  theory  more  or  less  applied  in 
his  writings,  where  if  things  do  not  go  right  he  takes  his  characters 
out  into  the  open  air. 

Unfortunately  on  his  second  tour  he  did  not  live  up  to  his 
theory,  he  did  not  offset  hours  in  bad  air  by  hours  in  good  air. 
Shall  we  say  that  infective  matter  or  toxic  products  accumulated 
at  a  greater  rate  than  the  defences  of  the  body  could  get  rid  of 
them? 

After  a  short  rest  in  England,  Dickens  concluded  to  give  one 
more  series  of  readings  in  his  own  country  and  then  retire  to  his 


1  A  physician  and  noted  lecturer  living  on  the  Atlantic  Coast  gave  an  address  before  the  same 
audience.  He  gave  a  fresh  air  lecture  but  overlooked  one  very  important  factor,  the  one  I  have  been 
trying  to  emphasize  in  this  volume.  The  following  from  an  Indianapolis  paper  looks  like  the  irony 
of  fate: 

"Dr. ,  the  man  who  has  been  telling  us  through  the  magazines  how  to  keep  ourselves  in 

good  health  and  enjoy  life,  is  in  such  poor  physical  condition  that  his  physician — doctors  do  not  trust 
themselves  to  prescribe  for  themselves — has  ordered  him  to  cancel  his  lecture  engagements  and  take  a 

complete  rest  for  six  months.     Dr. says  the  trouble  is  that  he  has  overworked,  but  is  he 

sure  that  he  has  not  been  living  up  to  his  own  rules  too  closely?" 

I  went  to  hear  these  lectures,  and  as  a  result  carried  away  a  "cold  that  hung  on"  for  two  weeks. 
I  went  hoping  to  escape  but  got  caught.  I  have  no  doubt  that  many  others  in  that  audience  were 
similarly  caught. 


324  DUSTY   AIR   AND  ILL   HEALTH. 

country  home.  One  is  reminded  of  the  suburbanite  who  jumped 
off  his  train  before  it  came  to  a  stop.  He  did  this  a  hundred  times 
luit  lie  did  it  once  too  often.  To  the  student  of  common  ill  health 
and  environmental  influences  it  is  clear  that  Dickens  should  not 
have  attempted  to  give  another  series  of  readings  after  his  Ameri- 
can tour;  his  health  was  too  much  shattered.  In  fact  he  did  not 
complete  the  final  series.  One  feels  that  he  died  prematurely.  He 
evidently  was  a  cardio-vascular  dust  victim,  with  a  high  blood 
pressure. 

There  are  any  number  of  topics  that  one  can  work  out  from  the 
data  contained  in  Dickens's  biography  and  letters.  A  very  interest- 
ing one  is  his  relationship  to  the  medical  profession.  One  would 
assume  that  a  man  of  such  eminence  would  have  the  best  physi- 
cians of  the  community  and  country,  and  this  in  general  was  true ; 
but  unfortunately  the  medical  men  whom  he  consulted  were  sur- 
geons rather  than  physicians.  Today  there  is  of  course  a  greater 
gulf  between  the  two  than  at  that  time.  When  we  think  of  a  sur- 
geon we  think  of  surgical  operations.  The  surgeon  is  not  concerned 
with  ''mere  ill  health,"  its  cause  and  prevention.  But  on  the  other 
hand  the  physician  of  the  best  type,  especially  today,  is  always 
seeking  to  prevent,  not  only  disease  but  also  common  ill  health. 
He  tells  his  patient  what  to  do  and  what  not  to  do.  He  even  seeks 
to  avoid  the  need  for  surgical  operations.  Properly  considered, 
Dickens  never  got  the  square  deal  from  the  medical  profession. 
The  medical  men  did  not  study  him  in  the  light  of  the  influence 
of  environment.  On  carefully  considering  all  the  data  as  given 
in  his  biography  and  letters,  one  arrives  at  the  conclusion  that 
Dickens,  until  perhaps  the  very  end,  did  not  have  any  well-defined 
disease.  This  thought  bears  repetition.  It  would  seem  that  his 
chronic  ill  health  wras  merely  an  expression  of  unsanitary  life  con- 
ditions, particularly  bad  air  conditions.  Practically  all  his  symp- 
toms must  be  considered  in  the  light  of  warnings  from  nature  to 
desist,  to  get  out  into  good  air.  Dickens  like  Huxley  felt  well  phy- 
sically almost  as  soon  as  he  got  out  into  the  country — but  country 
life  means  isolation. 


BIOGRAPHY    AND   ILL   HEALTH.  325 

Dickens's  influence  on  the  masses  was  great.  He  was  a  sani- 
tarian, but  not  of  the  trained,  salaried  kind  ;  he  was  a  sanitarian  by 
instinct,  so  to  speak.  He  saw  unsanitary  conditions  that  failed  to 
be  recognized  by  the  medical  profession  of  his  time — and  only  too 
often  by  present  day  physicians.  He  was  not  a  scientist;  he  was 
a  literary  man.  In  writing  about  unsanitary  conditions,  especially 
of  the  lives  of  the  miserable  poor,  Dickens  did  not  appeal- to  the 
reason  ;  his  appeal  was  to  the  emotions.  He  wrote  novels,  fiction, 
but,  very  important  to  note,  his  stories  were  not  spun  wholly  out 
of  his  brain;  they  are  based  on  facts,  on  personal  observations. 
As  a  writer  he  depended  for  inspiration  upon  long  walks  about  the 
city,  he  knew  London  thoroughly.  He  got  into  all  the  back  streets 
and  alleys  and  slums  generally.  He  studied  humanity  as  well  as 
the  influence  of  environment  at  first  hand. 

The  influence  of  Dickens  as  a  sanitarian  crops  out  especially  in 
the  education  of  children.  His  influence  was  great.  Among  other 
things  he  insisted  upon  large  and  well-ventilated  school  rooms. 
And  yet  we  say  Dickens  is  a  caricaturist  and  out  of  date! 

That  Dickens  clearly  saw  the  influence  of  environment  is  evi- 
denced by  the  fact  that  his  outdoor  people,  farmers,  fishermen  and 
sailors,  are  strong,  robust,  ruddy  faced  people,  while  his  indoor 
people,  city  people,  are  thin,  sallow,  sickly,  usually  undersized,  the 
exceptions  merely  bringing  out  the  contrast. 

Dickens  was  eminently  sane  in  his  views  regarding  sanitation. 
He  fully  realized  the  importance  of  cleaning  up.  Cleanliness  is 
the  great  remedy  for  poverty  and  for  the  "slum  disease"  and  for 
ill  health  dependent  on  unsanitary  surroundings.  His  novels  are 
full  of  references. 

It  is  to  be  regretted  that  Dickens  did  not  live  a  few  years  longer 
and  write  a  novel  dwelling  particularly  on  the  evil  influence  of 
an  unsanitary  environment.  He  could  have  appealed  to  the  masses 
as  a  sanitarian  by  instinct. 

We  need  a  Dickens  to  describe  unsanitary  conditions  in  our 
country,  some  one  to  tell  us  of  the  importance  of  cleaning  up.  As 
matters  stand,  we  rely  too  much  upon  authorities,  often  incompe- 


326  DUSTY    AIR   AND    ILL   HEALTH. 

tent  and  negligent.  As  already  mentioned  under  schools,  parents 
expect  school  authorities  to  do  everything.  Moreover  the  people 
do  not  properly  support  Boards  of  Health.  Unfortunately,  these 
are  too  often  composed  of  physicians  who  are  mere  figure-heads. 
The  people  should  be  represented  more  directly  on  Boards  of 
Health.  There  should  be  business  men,  manufacturers,  teachers, 
lawyers,  perhaps  even  a  preacher,  on  our  Boards  of  Health,  and 
certainly  a  club  woman  interested  in  the  matter  of  health  and  ill 
health.  The  women  can  show  the  men  how  to  clean  up.  Individ- 
uals who  are  mere  figureheads  should  be  recalled. 

Although  Dickens  had  much  to  say  regarding  our  national 
chewing  and  spitting  habit,  he  never  traced  the  relationship  of 
our  "Triad  of  National  Diseases"  to  it.  He  did  not  even  mention 
that  the  tobacco  chewer  encourages  others  to  spit,  notably  those 
who  are  catarrhal  or  tubercular.  If  he  had  had  only  an  inkling 
he  might  have  written  a  novel  directing  attention  to  pulverized 
spittle  as  a  cause  of  national  ill  health,  impressing  the  people  as 
no  scientific  writer  can. 

Thomas  H.  Huxley.  Huxley  came  to  London  as  a  young  man. 
He  withstood  bad  air  conditions  quite  well  at  first  but  in  the  course 
of  years  complained  more  and  more.  He  started  out  to  be  a  physi- 
cian but  ultimately  became  a  teacher  of  some  of  the  sciences  on 
which  Medicine  rests,  and  that  means  he  was  constantly  in  contact 
with  the  best  medical  men  of  London.  The  two  volumes  of  Life 
and  Letters  are  full  of  references  to  ill  health.  As  a  matter  of 
fact  his  ill  health  must  be  regarded  as  a  reaction  to  an  unsanitary 
environment,  to  bad  air  conditions.  His  physicians  at  times  would 
send  him  to  the  country,  to  Switzerland,  and  even  to  Egypt,  and 
his  health  would  improve  at  once,  but  he  would  relapse  on  getting 
back  to  the  city.  Of  course  he  had  all  sorts  of  opinions  from  doc- 
tors. Although  Huxley  did  not  know  of  dnst  infection  (he  lived 
before  the  days  of  bacteriology)  yet  he  realized  that  air  conditions 
and  crowds  influenced  him ;  he  learned  many  little  things  about 
avoiding  ill  health.  He  was  continually  trying  to  find  his  limita- 
tions.   When  he  came  to  this  country  he  was  careful  about  avoid- 


BIOGRAPHY   AND   ILL   HEALTH.  327 

ing  crowds.  He  gave  only  a  few  lectures  to  selected  audiences; 
had  he  done  otherwise  one  feels  he  would  have  broken  down.  After 
quitting  London  and  residing  on  the  seashore,  he  took  a  new  lease 
on  life.    He  lived  beyond  the  allotted  "three  score  and  ten." 

It  is  interesting  to  note  expressions  used  by  Huxley  in  telling 
about  his  bodily  condition,  about  his  ill  health.  Besides  common 
terms  such  as  coughing,  headache,  nausea,  and  vomiting,  he  uses 
such  expressions  as  shaky  voice;  scarcely  had  a  voice;  morbid  state 
of  mucous  membranes ;  a  shot  at  bronchitis ;  confounded  stomach ; 
hypochondriacal  dyspepsia;  intestinum  colon  plays  a  trick  every 
now  and  then;  general  nervous  depression :  blue  devils  (used  re- 
peatedly); curious  nervous  irritability;  hypochondriacal  depres- 
sion; neuralgia  or  rheumatism  or  whatever  it  is.  There  is  a  long 
list  of  such  and  similar  expressions. 

Herbert  Spencer  Avas  likewise  a  dust  victim  but  unlike  Hux- 
ley his  work  did  not  bring  him  in  constant  contact  with  the  best 
physicians,  in  fact  he  complains  that  some  physicians  whom  he  con- 
sulted did  him  more  harm  than  good.  Like  Huxley  he  was  always 
trying  to  find  his  limitations,  under  what  conditions  he  could  live 
with  the  least  ill  health.  He  spent  much  time  on  vacations  in  the 
country.  Huxley  tells  how  he  was  trying  to  find  his  juste  milieu, 
the  conditions  under  which  he  could  best  exist ;  Spencer  speaks  of 
wanting  a  keeper,  some  one  who  will  tell  him  what  to  do  and  what 
not  to  do. 

"When  Spencer  came  to  our  country  he  was  exceedingly  care- 
ful to  avoid  crowds.  He  was  importuned  to  give  public  lectures 
but  refused,  although  the  terms  were  flattering  and  he  greatly 
needed  money  to  publish  his  books,  since  they  appealed  to  a  lim- 
ited number  of  readers  only.  Spencer  lived  on  to  old  age.  He  may 
be  cited  as  an  example  of  the  English  saying,  Acquire  an  incurable 
disease  and  live  long,  always  keeping  in  mind  what  "disease" 
means. 

A  study  of  the  life  and  writings  of  these  three  men  is  also  of 
interest  on  account  of  their  views  regarding  education,  "What 
education  is  of  most  worth?" 


X. 

PERILS  AND  A  REMEDY. 


We  are  constantly  told  of  perils  and  chief  perils  that  threaten 
us,  our  cities  and  our  country,  if  not  the  world  as  a  whole,  and 
how  mankind  is  on  the  verge  of  extinction.  Those  who  unduly 
magnify  perils  are  called  alarmists.  Those  who  study  certain  top- 
ics may  see  perils  that  wholly  escape  the  observations  (or  shall  we 
say  the  "imagination"?)  of  others.  Some  articles  in  newspapers 
and  magazines  make  use  think,  others  make  us  smile,  depending 
largely  on  the  viewpoint. 

In  discussing  the  dust  problem  with  patients  a  physician  finds 
all  sorts  of  people,  those  who  make  light  of  the  whole  subject  to 
those  who  see  the  gravest  danger  and  who  wonder  that  they  are 
still  alive  or  that  man  has  not  long  ago  disappeared  from  the  face 
of  the  earth.  To  the  one  class  the  physician  must  show  that  the 
dust  peril  is  a  real  peril,  that  it  is  in  operation  all  about  us,  not 
only  in  the  production  of  ill  health  but  in  destroying  life  as  well 
as  in  the  matter  of  "race  suicide."  On  the  other  hand  those  who 
are  unduly  alarmed  must  be  told  that  the  very  fact  that  they  are 
alive  is  good  evidence  that  the  danger  is  not  as  great  as  they  be- 
lieve, think,  or  imagine.  Although  the  susceptible  are  constantly 
being  killed  off,  there  are  any  number  of  survivors  that  can  live 
under  present  day  conditions,  although  perhaps  complaining  more 
or  less  of  ill  health.  One  can  point  out  that  under  sanitation  many 
diseases  have  practically  disappeared,  some  are  known  only  by 
name,  and  that  the  average  length  of  life  has  been  greatly  increased. 
Just  as  there  has  been  a  diminution  of  diseases  and  ill  health  on  ac- 
count of  getting  good  water,  so  there  will  be  better  health  with 
good  air. 

There  are  perils  everywhere,  by  knowing  about  them  we  can 

(328) 


PERILS   AND    A   REMEDY.  329 

largely  guard  ourselves.  Our  street  car  company  recently  put  up 
signs  regarding  the  peril  of  stepping  off  backward.  In  issuing 
these  warnings  the  street  car  company  aims  to  protect  its  passen- 
gers and  also  itself,  injuries  are  often  wholly  avoidable  or  prevent- 
able. Many  people  are  always  getting  off  backward  in  all  walks 
of  life.  They  are  surrounded  by  all  sorts  of  perils,  they  must  be 
told  how  to  act.  We  hear  much  of  publicity  to-day.  It  is  becom- 
ing clearly  recognized  that  when  a  peril  is  freely  discussed  we  are 
on  the  right  road  to  lessen  it. 

Dr.  Saleeby  in  his  very  sensible  book,  Health,  Strength  and 
Happiness,  says  in  the  very  beginning: 

"Such  books  as  this  might  be  are  amongst  the  chief  makers  of  hypo- 
chondriacs— people  who  make  themselves  ill  by  trying  to  keep  well." 
(p.  9.) 

A  few  pages  further  on  under  the  head  of  "The  Need  of  Air" 

he  says: 

"A  full  discussion  of  this  question  can  not  injure  even  the  most  sug- 
gestible and  hysterically-inclined  woman.  I  really  do  not  think  that  any 
one  can  be  too  fussy  about  the  need  of  pure  air,  though  millions  of  people 
are  too  fussy  about  the  need  for  its  exclusion.  Such  persons  have,  in 
every  case,  made  themselves  susceptible  to  draughts,  and  can  undo  their 
burdensome  handiwork.  Further,  the  man  or  woman  who  is  fussy  about 
the  need  for  fresh  air  is  benefiting  other  people  besides  himself,  and  earns, 
though  he  does  not  obtain,  the  thanks  of  all  except  the  tubercle  bacillus. 
I  hope  this  chapter  will  afford  fresh  power  to  his  elbow."     (p.  25.) 

The  Remedy.  When  an  alarmist  points  out  a  peril  he  usually 
also  suggests  a  remedy,  what  we  must  do  to  be  saved.  To  what 
extent  is  dust  a  peril  1  Views  are  apt  to  vary  widely.  The  marked 
dust  victim  may  over-emphasize  it.  The  immune  may  make  light 
of  it.  Those  who  have  never  had  their  attention  directed  to  the 
subject  are  likely  to  consider  the  matter  largely  in  the  light  of 
their  own  susceptibility.  The  reader  should  not  arrive  at  hasty 
conclusions,  now  that  his  attention  has  been  called  to  the  matter 
he  should  observe. 

Of  course  everybody  tries  to  avoid  dust,  many  merely  because 
it  is  dirty,  it  soils  the  clothing,  it  is  disagreeable,  unpleasant.  They 


330  DUSTY    AIR   AND   ILL   HEALTH. 

regard  it  as  a  nuisance  rather  than  as  a  menace  to  health.  The 
wise  physician  when  he  sees  a  dust  cloud  coming  down  the  street 
says,  There  is  money  in  that  for  me — if  the  people  only  knew! 

During  the  open  door  season,  during  summer,  the  doctor,  the 
general  practitioner,  has  little  to  do  but  he  knows  the  moment  the 
schools  open  and  the  children  are  massed  together  in  unsanitary 
school  buildings  he  will  begin  to  get  busy  and  when  the  cooler 
days  come  and  people  house  themselves  up  he  gets  very  busy. 
Medical  inspection  of  school  children  has  been  brought  forward  as 
a  remedy,  as  far  as  relates  to  school  children.  To  inspect  and  to 
report  does  not  mean  to  prevent  but  that  no  doubt  will  be  the  next 
step.  Cleaning  up  is  the  remedy.  The  community  as  a  whole 
should  be  inspected  and  made  clean. 

Formerly  cities  were  very  unsanitary,  as  they  are  still  in  back- 
ward communities.  On  account  of  the  massing  of  humanity  ills 
and  diseases  of  all  kinds  were  rife,  morbidity  and  mortality  rates 
were  high.  To  understand  this  fully  we  must  read  about  condi- 
tions as  they  existed  a  hundred  and  more  years  ago.  New  coun- 
tries largely  go  through  the  same  cycle  as  the  old  ones.  Adam 
Smith  wrote  of  the  large  number  of  children  born  to  Scotch  moth- 
ers and  how  out  of  twelve  or  fifteen  only  one  or  two  would  survive. 
At  the  same  time  Benjamin  Franklin  was  telling  of  the  large  fam- 
ilies in  our  own  country.  Since  then  conditions  have  radically 
changed.  Old  European  cities  have  cleaned  up  and  have  greatly 
reduced  their  death  rate ;  cities  are  almost  self-sustaining  now,  no 
longer  dependent  on  the  constant  influx  of  country  blood.  On  the 
other  hand  conditions  in  our  own  country  have  grown  progres- 
sively worse,  as  evidenced  by  small  families  and  the  cry  of  race 
suicide.  Although  we  are  able  to  keep  out  many  diseases  such  as 
cholera  and  the  plague,  yet  many  of  the  old  time  diseases  flourish 
in  our  country,  besides  a  host  of  maladies  that  manifest  themselves 
as  ill  health  rather  than  well  defined  disease. 

In  early  days  there  was  no  milk  problem,  but  today  this  is  a 
serious  one  in  large  cities,  and  even  in  the  small  cities.  To  the  man 
who  keeps  a  cow  it  is  no  problem  at  all.     Milk  becomes  impure 


PERILS   AND   A   REMEDY.  331 

mainly  on  account  of  passing  through  many  hands.  Similarly  the 
water  problem  is  a  serious  one  to  cities  but  is  no  problem  to  the 
isolated  farmer. 

It  is  not  alone  human  beings  who  suffer  from  massing,  we  see 
the  same  thing  among  plants.  There  is  increasing  difficulty  in 
raising  farm  and  garden  crops.  When  the  soil  was  still  fertile  and 
pests  and  parasites  of  all  kinds  were  absent,  anybody  could  farm, 
just  as  anybody  could  raise  garden  truck  and  fruits.  Our  National 
Department  of  Agriculture  and  our  State  Experiment  Stations 
are  engaged  in  telling  the  farmer  and  the  horticulturist  how  to 
succeed  under  adverse  conditions — but  so  far  little  effort  has  been 
made  to  tell  him  how  to  raise  a  family  of  strong  and  healthy  chil- 
dren. The  farmer  who  lives  in  isolation  is  still  able  to  produce  a 
large  family  of  children  but  when  he  sends  them  to  unsanitary 
schools  or  to  unsanitary  cities  there  is  heavy  loss.  City  people  are 
reproducing  themselves  at  so  small  a  rate  that  there  is  a  constant 
cry  of  race  suicide. 

During  the  last  few  years  we  have  heard  much  about  Conser- 
vation, chiefly  about  conserving  our  national  resources,  now  that 
some  are  almost  exhausted.  There  is  even  a  movement  to  "con- 
serve national  health."  All  sorts  of  efforts  are  made  to  prevent 
the  loss  of  human  life.  "We  have  railroad  commissions  that  seek  to 
prevent  accidents;  the}'  tell  us  how  many  hundreds  of  lives  have 
been  saved.  Cities  appoint  pure  milk  commissions  and  tell  us  how 
many  lives  of  infants  are  saved.  Cities  develop  a  pure  water  con- 
science, people  demand  and  get  good  water  and  then  we  are  told 
how  many  lives  have  been  saved  from  typhoid  fever.  We  have 
pure  food  laws  and  ordinances  of  all  kinds  and  statisticians  are 
inclined  to  speak  of  the  number  of  lives  saved.  Physicians  speak 
of  their  efforts  in  saving  lives,  as  for  instance  in  building  the  Pan- 
ama Canal.  There  are  all  sorts  of  efforts  but  we  are  only  begin- 
ning to  realize  the  need  for  good  air.  This  has  manifested  itself 
so  far  mainly  by  smoke  commissions,  seeking  to  do  away  with  the 
"smoke  evil."  We  are  only  beginning  to  understand  the  dust 
evil.    If  the  people  knew  to  what  extent  dust  is  the  cause  of  ill 


332  DUSTY    AIR    AND    ILL    HEALTH. 

health  and  disease  they  would  make  radical  efforts  in  dust  pre- 
vention and  in  cleaning:  up. 

The  people  simply  do  not  realize  the  amount  of  ill  health  and 
disease  that  is  dependent  on  the  dust  evil.  Although  in  our  country 
the  amount  of  well-defined  disease  is  being  reduced  the  amount  of 
ill  health  is  increasing,  for  various  reasons,  chiefly  from  the  fact 
that  as  sanitation  reduces  specific  diseases  people  who  ordinarily 
would  have  perished  live  on  and  are  subject  to  ill  health  that  is 
not  sufficiently  severe  to  kill.  During  the  prevalence  of  an  epi- 
demic those  who  have  a  "lowered  vitality,"  who  have  had  more 
or  less  ill  health  are  largely  weeded  out.  In  proportion  as  such 
diseases  are  kept  in  check  people  live  on  and  on.  Prudent  people 
of  course  guard  themselves  at  all  times.  The  man  in  chronic  ill 
health  may  be  unusually  careful.  The  well-to-do  who  can  properly 
do  this  live  on  and  on  while  the  poor  man  who  must  work  perishes 
early  and  only  too  often  leaves  a  large  family  of  small  children. 
If  the  community  as  a  whole  were  interested  in  sanitation  the  poor 
man  would  have  a  better  chance  of  surviving,  of  reaching  a  greater 
age.  Naturally  there  are  all  sorts  of  remedies  proposed,  especially 
superficial  ones.  While  the  sanitarian  insists  upon  cleaning  up, 
there  are  still  people  who  oppose  such  measures.  There  is  a  sect 
of  fanatics  who  deny  that  there  is  such  a  thing  as  disease,  and 
then  there  are  those  who  while  not  denying  disease  believe  in  ig- 
noring it,  who  try  to  delude  themselves.  The  "New  Thought  Move- 
ment" and  faith  cures  have  been  put  forth  as  remedies.  But  there 
is  nothing  new  about  these ;  such  remedies  are  old,  such  views  take 
us  back  to  primitive  times.  The  physician  of  today  believes  that 
most  mental  ills  are  dependent  on  physical  conditions.  The  an- 
cient Greek  philosopher  said,  Know  Thyself.  The  modern  sani- 
tarian advises.  Know  your  city.  The  evolutionist  tells  us  to  study 
our  environment,  that  our  health  and  ill  health  are  largely  depend- 
ent upon  it.  Environmental  influences  may  be  regarded  as  the 
influence  of  surroundings. 

In  speaking  of  the  evils  entailed  by  the  lack  of  knowledge  of  sur- 
roundings, Ward  says:     "Indeed,  the  greater  part  of  all  suffering  is  the 


PERILS   AND   A    REMEDY.  333 

it-suit,  direct  or  remote,  of  such  ignorance.  Obviously,  therefore,  the  first 
great  duty  of  man  is  to  acquaint  himself  with  his  environment.  This  can 
only  be  done  by  study.  The  phenomena  that  lie  on  the  surface  are  of  little 
value.  They  mislead  at  every  turn.  Not  only  must  the  deep-lying  facts, 
difficult  of  access,  be  sought  out  with  great  labor  and  perseverance,  but 
they  must  be  co-ordinated  into  laws  capable  of  affording  safe  and  reliable 
guides  to  human  operations.  To  do  this  requires  a  vast  amount  of  patient 
study.  Only  a  little  has  yet  been  revealed  of  the  more  important  truths 
of  nature,  yet  consider  the  amount  of  research  which  it  has  required ! 
Nevertheless,  only  a  few  individuals  have  contributed  anything  at  all  to 
the  result.  It  is  as  yet  only  the  simpler  and  more  obvious  relations  'be- 
tween man  and  nature  that  have  determined.  In  the  domain  of  physical 
forces  and  chemical  substances  he  is  able  to  exercise  previsi'on  in  many 
ways  to  secure  advantages  and  avert  evils,  but  in  most  of  the  higher  fields 
of  \ital,  mental,  moral,  and  social  phenomena,  these  relations  are  either 
utterly  ignored  or  but  dimly  suspected,  so  that  his  knowledge  of  them 
avails  him  nothing.  The  great  work  before  him,  therefore,  still  is  study." 
(Lester  F.  Ward,  Dynamic  Sociology,  Vol.  II,  p.  11.) 

He  further  says :  "But  what  constitutes  the  environment  of  the 
civilized  man?  The  character  of  the  environment  of  animals  and  of  savage 
man  is  easy  to  perceive.  It  is  the  earth,  the  air,  the  rocks  and  waters, 
the  trees,  grass,  birds  and  animals,  the  last  to  include,  in  the  case  of  the 
savage,  the  men  of  his  own  tribe  and  of  other  tribes,  and  also  civilized 
races,  in  case  any  such  ever  come  in  contact  with  him.  It  is  by  learning 
to  know  these  things  that  he  is  enabled  to  protect  and  defend  himself. 

"But,  looking  to  races  somewhat  more  advanced  than  the  crude  savage, 
we  find,  as  frequently  shown  before,  that  their  advancement  has  been  due 
to  action  on  their  part  in  taking  advantage  of  certain  deeper  laws  of 
'nature,  in  making  use  of  materials  that  savages  fail  to  make  use  of,  in 
interpreting  phenomena  that  savages  do  not  correctly  interpret,  and, 
through  these  means,  in  devising  plaDS  and  inventing  appliances  for  mul- 
tiplying the  products  of  nature  and  increasing  the  supply  of  physical, 
social,  and  intellectual  wants.  And,  when  we  have  reached  the  highest 
forms  of  social  existence,  we  find  that  the  only  effective  means  by  which 
desire  is  gratified,  progress  achieved,  and  happiness  attained,  consist  in 
still  deeper  knowledge  of  the  natural  surroundings,  in  a  still  wider  grasp 
of  laws  and  principles,  in  the  correct  interpretation  of  still  more  obscure 
phenomena,  and  in  the  discovery  and  invention  of  still  better  means  and 
methods  of  securing  remote  ends.  To  know  one's  environment  is  to  possess 
the  most  real,  the  most  practical,  the  most  useful  of  all  kinds  of  knowledge, 
and,  properly  viewed,  this .  class  of  information  constitutes  the  only  true 
knowledge."     (Vol.  II,  p.  495.) 

In  discussing  the  expression  "knowledge  of  the  environment,"'  Ward 
comes  to  the  conclusion  that  it  is  co-extensive  and  synonymous  with  the 
word  science.     "Knowledge  of  man's  environment  is  nothing  more  nor  less 


334  DUSTY   AIR   AND   ILL   HEALTH. 

than  scientific  knowledge;  and.  conversely,  all  scientific  knowledge  con- 
sists in  knowledge  of  the  environment.  .  .  .  The  only  useful  knowledge 
is  that  which  furnishes  relations.  Isolated  facts,  until  employed  for  this 
purpose,  are  not  really  employed  at  all.  An  object  known  only  in  itself 
ran  scarcely  he  said  to  be  known.  .  .  .  Science  is  dynamic.  Whatever 
it  touches  is  transformed.  The  only  object  in  knowing  is  by  means  of  it 
to  do  something    .     .     ." 

Ward  refers  to  the  attenuation  of  knowledge  and  of  getting  away 
from  things,  and  how  especially  in  the  Middle  Ages  men  were  inclined  to 
neglect  facts,  and  how  science  brings  us  back  to  facts  and  to  nature.  We 
can  readily  see  how  students  of  environment  and  environmental  influences 
are  not  likely  to  be  misled  by  the  present  fad  of  psychotherapy.  Ward  also 
refers  to  much  of  our  literature  as  being  simply  a  jugglery  of  words, 
pleasing  to  the  ears,  but  of  little  value  in  keeping  man  acquainted  with  his 
environment. 

Perhaps  few  of  us  realize  fully  the  importance  of  environmental  in- 
fluences, of  how  our  life,  our  thoughts  and  actions,  are  dependent  thereon. 
No  doubt  many  of  us  have  at  times  wondered  what  our  own  life  and  the 
life  of  others  would  be  under  different  surroundings.1 

Today  we  hear  much  regarding  a  return  to  the  simple  life. 
That  is  by  some  considered  a  cure  for  many  ills,  including  race 
suicide.  What  do  we  mean  by  the  simple  life?  Does  it  mean  a 
return  to  earlier  primitive  conditions,  to  a  stage,  for  instance,  seen 
in  the  southern  mountains  where  people  are  healthy  and  live  long  ? 
It  is  sometimes  said  that  the  southern  mountaineers  are  a  hun- 
dred years  behind  in  their  civilization.  Some  countries  are  far  be- 
hind. How  many  would  prefer  "fifty  years  of  Europe  than  a 
cycle  of  Cathay"?  How  many  after  living  the  complex  life  of 
today  are  really  willing  to  return  to  simple  conditions?  Accord- 
ing to  my  experience  there  are  so  few  that  they  are  scarcely  worth 
considering  at  all.  There  is  of  course  much  that  can  be  simplified. 
"Good  taste"  itself  seeks  the  simple.  We  often  hear  the  rich  and 
the  new-rich  compared;  too  many  want  to  show  their  money  by 
gaudy  display. 

As  civilization  advances  and  life  becomes  more  complex  a  re- 
turn to  primitive  conditions  is  not  a  remedy.  People  outgrow 
primitive  ideas  of  religion,  of  government  and  State  constitutions. 

Even  the  physician  outgrows  the  traditions  of  his  profession. 


Biography  and  the  Influence  of  Environment,  Ind.  Acad.  Science,  1908. 


PERILS   AND   A   REMEDY.  335 

The  old  time  physician  was  a  good  Samaritan  who  bound  up  wounds 
but  the  physician  of  today  attempts  to  prevent  the  infliction  of 
wounds.  The  old  time  physician  promptly  handed  out  medicine 
to  those  who  came  to  him  complaining;  old  tradition  demands  that 
any  one  applying  to  a  physician  should  be  given  aid  or  relief  and 
no  questions  asked  regarding  compensation.  But  times  have 
changed.  Not  so  very  long  ago  the  physician  did  not  ask  for  a  fee 
at  all — he  was  supposed  to  be  above  that,  he  "expected  a  honor- 
arium. ' '  The  physician  of  today  has  gotten  away  from  such  ideas, 
he  believes  the  laborer  worthy  of  his  hire  and  asks  for  his  fee  or 
sends  in  his  bill  for  services  rendered.  The  modern  laboratory 
doctor  is  not  bound  by  old  traditions.  He  investigates  fully  before 
advising  and  prescribing,  that  means  much  time  is  given  those  ac- 
cepted. He  is  apt  to  inquire  in  the  very  beginning  what  he  will 
get  in  return.  As  in  all  other  walks  of  life,  the  man  who  has  little 
to  give  gets  little.  ' '  For  he  that  hath,  to  him  shall  be  given :  and 
he  that  hath  not,  from  him  shall  be  taken  even  that  which  he 
hath."  The  physician  of  today  is  inclined  to  place  the  blame  for 
the  prevalence  of  ill  health  and  injuries  of  many  kinds  where  it 
properly  belongs.  The  people  are  beginning  to  realize  that  many 
injuries,  as  from  railway  accidents,  are  preventable;  they  are  be- 
ginning to  realize  that  many  deaths  from  impure  water  are  pre- 
ventable, cities  supply  themselves  with  good  water.  We  are  be- 
ginning to  understand  that  the  ravages  of  tuberculosis  are  largely 
preventable  by  good  air. 

It  is  perhaps  useless  to  attempt  to  teach  old  people  regarding 
the  importance  of  sanitation  and  hygiene,  whose  chief  law  is  that 
of  cleanliness.  But  it  is  worth  while  to  teach  the  young;  they 
learn  readily  and  remember.  The  place  above  all  others  that  should 
be  clean,  where  in  fact  the  importance  of  cleanliness  should  be 
taught,  is  the  common  school.  From  there  the  teachings  are  spread. 
But  in  order  that  the  children  may  be  taught  the  teachers  must 
first  be  taught.  Where  shall  the  process  of  teaching  the  impor- 
tance of  cleanliness  begin?  Shall  it  be  left  to  the  authorities  or 
shall  it  be  left  to  the  people?     Or  do  the  people  still  expect  the 


^36  DUST*    AIR    AND   ILL   HEALTH. 

general  practitioner  of  medicine  to  teach  them?  As  a  rule  peo- 
ple do  not  call  upon  the  physician  until  they  are  sick;  is  the  bed- 
side a  good  place  to  teach  the  importance  of  sanitation?  Who 
makes  the  best  Btreel  commissioner  to  direct  street  cleaning,  a  man 
or  a  woman)  Who  makes  the  best  sanitarian,  the  physician  in 
private  practice  depending  for  his  bread  and  butter  on  the  mis- 
fortunes of  his  fellow-citizens  or  the  trained  sanitarian  paid  by  the 
community,  the  man  who  has  nothing  to  lose  from  the  enemies  he 
makes?  Is  it  necessary  to  add  that  the  right  of  a  man  in  ill  health 
to  prescribe  for  himself  or  to  employ  some  one  to  "doctor"  him 
will  likely  be  conceded?  The  wise  man  will  likely  employ  a  skilled 
physician  to  look  after  him.  just  as  the  wise  community  will  em- 
ploy a  skilled  sanitarian  to  look  after  the  communal  welfare. 


APPENDIX 


[22]  (337) 


INDEX 


A-b-c  explanations,  228. 

"Abe  Martin"  and  Pump  Towns,  23. 

Acetanilid,  224,  237. 

Adaptation,  35,  50. 

Adenoids,  85. 

Advertising  doctor,  222. 

Advertisements,  newspaper,  235. 

Advising  a  patient  to  move,  271. 

Agassiz,  165. 

Age  and  arteries,  262. 

Age  and  high  blood  pressure,  264. 

Air,  bad   (a  synonym),  65. 

dust  free,  129,  148. 

good  (synonym  for  clean), 

night,  18. 

open,  20,  28,  276,  323. 

pure  (synonym  for  clean), 

of  Places,  99,  146. 
Albumin,  260. 
Alcohol,  24,  224,  237. 
Alcott,  Louisa  M.,  316. 
Alteratives,  249. 

American  Catarrh,  69,  103,  105,  175, 
322,  323. 

Diseases  (see  Triad  of). 

Dyspepsia,  175,  322. 

Nervous  Prostration,  322. 

Notes,  Dickens,  321. 

spitting  habit,  69,  321. 

tours,  Dickens,  321. 
Analogies,  plants  and  animals,  85. 

animals  and  man,  288. 

diseases  and  plants,  289. 

weeds  and  diseases,  300. 
Ancestors,  rural  or  urban,  34,  122. 
Anemia,  185,  276. 
Anopheles  (mosquito),  49,  53,  289. 
Anophelesis,  49. 
Anorexia  (loss  of  appetite), 

276,  186. 
Antagonism  to  physicians,  214. 
Anthracosis,  72. 
"Anti"  remedies,  130. 
Anti-smoke  laws,  69. 
Anti-spitting  ordinance,  148,  221. 
Antitoxin  and  diphtheria,  294. 
Antitoxin  and  tuberculosis,  294. 
Appendicitis,  167. 
Appetizers,  186. 
Apoplexy,  258,  273,  76. 


Arabs  and  odors,  92. 
Arteries  and  age,  256,  262. 
Arteries,  soft  and  Indian,  263. 
Arterio-sclerosis,  286. 
Asthenia   (lack  of  strength),  276. 
Attic  colds,  107. 
Atypical  cases,  172. 
Autobiographies,  155,  303. 
Autobiographic  case  report,  304. 
Autobiography,  196. 
Auto-intoxication,   168,  170. 
Automobile  colds,  107. 
Autumnal  catarrh,  65. 
Average  patient,  305. 


Backache,  131,  145,  288. 
Backward  communities,  57,  330. 
Bacteriology,  24,  29. 

and  explanations,  146. 
Bacillus  tuberculosis,  147. 
Bad  air  influences,  220. 
Baldness,  premature,  282. 
Barber's  itch,  254. 
Beard,  Dr.,  and  neurasthenia,  213. 
Becoming  hardened,  281. 
"Being  Done  Good,"  Lent,  132,  183. 
"Beneficent  Dust,"  68. 
Best  citizens  and  politics,  239. 

family  paper,  229. 

family  physician,  236. 

patients,  252. 

vs.  worst  people,  178. 
"Best  of  health"  and  life  insur- 
ance, 259. 
"Better  class,"  303. 
"Beware  of  a  cold,"  296. 
Bilious,  167. 
Biliousness,  169. 
Biography,  18,  93,  129. 

and  Environment,  313. 

and  111  Health,  302. 
Biology,  problems,   183. 
Bladder,  irritable,  190. 
Bleeding  and  purging,  59. 
Blood  count,  176. 

poisoning,  131,  299. 

pressure,  76,  198,  258,  279,  285. 

purifiers,  101. 

vessels,  283. 


(23) 


(341) 


342 


DUSTY   AIR    AND    ILL   HEALTH. 


Boards  of  Health,  111,  326. 
Blue  Monday,  10S. 
Blues,  the.  192,  212. 
Boil  the  water,  22,  27. 
Book,  dust,  66. 

dust  colds,  107. 
Books,  old  dusty,  316,  319. 

German,  256. 
Bookworms,  314. 
"Boost,  Don't  Knock,"  322. 
"Break  the  fever,"  278. 
Breath,  getting  out  of,  277. 
Bright's  Disease,  146,  25S. 

and  backache,  2S0,  288. 
Bronchitis.  286. 
Browning.  Mrs.  E.  B.,  317. 
Bryant,  William  Cullen,  and  ma- 
laria, 18. 
Byssinosis,  72. 

Cancer  fear,  164. 

of  the  stomach,  172. 
Captain  of  death.  296. 

of  industry,  262. 
Cardio-vaseular  affections,  258. 

Case  Report,  266. 

type,  76. 
Carlyles,  the.  26S,  300,  318. 
Carpet  colds,  108. 

Case  Reports,  84,  90,  93,  132,  133, 
137,  139,  140,  144,  152,  153,  160, 
161,  163,  175,  176,  178,  181.  197. 
199,  200,  202,  204,  205,  206,  20S, 
217,  225,  230,  242,  253.  266,  294, 
304. 
Case  Reports  at  secondhand, 
306,  309. 

dry-as-dust,  93. 

in  journals,  311. 

cancer,  stomach,  172. 

reprinted,  84,  90,  176.  304. 
Case  Notes  at  secondhand,  196. 
Cases,  "interesting,"  41. 

reporting,  216. 

selected,  310. 

successful  and  unsuccessful,  140. 

typical  and  atypical,  172. 
Catarrh,  American,  69,  175. 

infective  and  non-infective,  104. 
Catarrhal  diathesis,  104. 
"Catching  cold."  99,  113,  188. 
"Catching  disease,"  30. 
Cathartics,  167,  170.  1S9,  224. 
Cathay  vs.  Europe,  334. 
"Caught  more  cold,"  117. 
Century  Clubs,  256. 


Chalicosis,  72. 
Change  of  air,  153. 

of  climate,  127. 
Changes  in  climate,  15. 

in  Indiana,  45. 
Charlatans,  135. 
Chautauqua  salute,  70. 
Chemists  and  explanations,  146. 
Chest,  oppression  in,  189. 
Ohewer  and  spitter,  242. 
Chewing  tobacco,  69. 
Chief  perils.  44,  328. 
Children,  delicate,  133. 

hardening,  281. 

in  isolation,  86. 

newborn,  123. 

school  life,  123. 
Chills  and  chilling,  186,  277. 
Chinese  cities,  14S. 
Cholera,  290,  51,  259,  287. 

fear,  290. 
Christmas  colds,  108. 
Chronics  and  symptoms,  288. 
Chronology  and  biography,  319. 
Church,  52. 

colds,  10S. 

doorkeeper,  270. 

going  or  not,  108,  269. 
City  cases,  160. 

doctor,  16,  208. 

dust,  63. 
Cities,  backward,  142. 

fortified,  143. 

and  country  blood,  330. 
Civilization,  142. 

diseases  of,  130. 

Greek  and  Roman,  290. 

stages  of,  62. 

and  malaria,  290. 
Classifying  colds,  106. 

diseases,  55,  212. 

dust  victims,  73. 

patients,  76. 

people,  77. 
Clean  air,  238. 

food,  19,  23,  238. 

streets,  143,  238. 

water,  23.  23S. 
Clean  Up,  Clean  Out,  Keep  Clean, 

32.  167. 
Cleaning  up,  123,  219,  237,  2S7, 
293,  330. 

and  women,  326. 

and  pat.  med.  ads,  225. 
Cleanliness,  surgical,  174. 
Clergyman's  sore  throat,  206. 


INDEX. 


343 


Clerks  in  stores,  217. 
Climate,  127. 

changes  in,  15. 

"horrible,"  138. 

indoor,  33,  128. 

"wonderful,"  130. 
Closed  door  season,  137,  170. 

and  pat.  med.  ads,  225. 
Clothing,  283. 

"healthiest  color,"  23. 

red  flannel,  23. 
Clubs  and  Club  women,  239. 
Coal  tar  preparations,  224. 
Cocaine,  237. 
Cold  cures.  233. 
Colds,  74,  188. 

attic,  107. 

automobile,  107. 

book  dust,  107. 

carpet,  108. 

church,  108. 

classifying,  106. 

court-house,  109. 

dance-hall,  109. 

housecleaning,  110. 

manifestations,  116. 

railway,  110. 

school,  111. 

State  Fair,  96. 

tax  payer's,  98. 

that  hang  on,  99. 

vacuum  cleaner,  112. 

and  Ben.  Franklin,  213. 
catarrh,  103. 
cold,  103. 
exposure,  114. 
indoor  life,  105. 
Colonizing,  33. 
Common  factor,  102. 
Communal  welfare,  336. 
Communists,  24. 
Compensations,  288. 
Complexion,  185,  282. 

cures,  282. 

vs.  pain,  282. 

and  good  air,  282. 
Concealed  malaria,  18. 
Conclusions,  hasty,  329. 
Conditions  for  catching  colds,  113. 
Confession  of  ignorance,  152, 

174,  214. 
Congenial  people,  318. 
Congestive  chill,  188. 
Coniosis,  72,  174,  218. 
Conophobia  (dust  fear),  252. 
Conservation  movement,  331. 


Conservative  processes,  287. 
Constipation,  166,  189,  277. 

and  pat.  med.  ads,  160. 
Contagious  diseases  in  schools,  291. 
Contributing  factors,  21 8. 
Constriction  of  chest,  189. 
Continuous  data,  303. 
Co-operation,  43. 
Cough,  189,  277. 

cures,  231,  237. 
Country  ancestry,  265. 

boys  and  city,  262. 

doctor,  172,  208. 

doctor  and  medical  journals,  78. 

dust,  63. 

grub,  32. 

homes,  68. 

practice,  157. 

road  dust,  63. 
Court-house,  52,  294. 

air.  309. 

colds,  97,  109. 

officials,  241. 

and  women,  239. 
Crowd  Poison,  65,  73,  92,  321. 
"Cuckoo  Parents,"  111. 
Culture  media,  30. 
Cure  vs.  relief,  233. 
Cures,  outlandish,  311. 
Curing  or  killing,  141. 

a  cold,  233. 

vs.  benefiting,  92. 

vs.  relieving,  233. 
"Cystitis,"  190. 

Daily  record,  271,  180,  201. 

Dance-hall  colds,  109. 

Darkest  before  dawn,  96,  97, 101,  311. 

Data,  continuous,  303. 

Darwin,  Charles,  302,  319. 

Life  and  Letters,  313. 
Dead  finger  symptoms,  190. 
Death,  gradual  or  sudden,  273. 
Decline  of  life,  125. 
Delicate  people,  29. 
Department  of  Agriculture,  60.  331. 
Dickens,  Charles,  69,  103. 

"American  Notes,"  321. 

biography,  321. 

and  sanitation,  313,  325. 

and  spitting,  321. 

and  walking,  323. 
Diagnoses,  3S. 

offhand,  15. 
Diary,  272.     (See  also  Daily 
Record.) 


344 


DUSTY    AIB    AND    ILL   HEALTH. 


Diathesis,  catarrhal,  104. 
Differential  diagnosis,  171. 
Diphtheria,  294. 
Dirt  and  plague,  292. 
Dirty  water  vs.  dirty  streets,  23S. 
Disagreeable  dyspeptics,  216,  321. 
Discussing  symptoms,  185,  274. 
Discussions,  tabooed,  273. 

useless,  1S5. 
Disease,  ill  health,  symptoms,  244. 

symptoms,  275. 

"catching,"  30. 

'•knocking  out,"  156, 

names,  156. 

proof,  51,  88. 

vs.  ill  health,  42,  55. 

vs.  symptoms,  53. 

and  ill  health,  53. 
Diseases,  acute,  261. 

chronic,  261. 

classifying,  55,  212. 

collecting  cases,  301. 

industrial,  56. 

in  Indiana,  54. 

naming,  168. 

occupational,  56. 

terminal,  35. 

transmission,  300. 

Triad  of,  17,  76,  105,  167,  212, 
219,  236. 

of  civilization,  59,  130. 

vs.  affections,  2S7. 

vs.  symptoms,  286. 

and  causes,  48,  53,  213. 

and  Jews,  56. 
Disease-producing  microbes,  25. 
Dizziness,  195. 
Doctor,  advertising,  222. 

best  friends,  216. 

citv,  16,  208. 

country,  172,  20S. 

of  dead  towns,  222. 

making  a  living,  235. 

robust,  29.  207,  236. 

medicine,  232. 

and  criticism,  12. 

and  ideals,  235. 

and  meeting  places,  149. 

(see  also  under  Physician.) 
"Doctoring,"  32,  60,  197,  219. 
Dogmatic  statements,  156. 
Dogmatism,  253. 

Domesticated  animals  and  plants,  51. 
"Do  Not  Spit,"  70. 
Dreams  and  dreaming,  87,  190,  306. 


Dresses,  trailing,  65,  176. 
Drowning  as  a  "disease,"  245. 
Drugs,  61. 

Druggists,  15,  32,  57,  230. 
Dry-as-dust  Case  Reports,  93. 
Dry  cough,  190. 
1  ►ryness  of  skin,  281. 
Dust,  A  Neglected  Factor  in  111 
Health,  84,  95,  153,  176,  304. 

as  a  factor,  306. 

as  a  menace,  330. 

as  a  nuisance,  330. 

clouds,  330. 

evil,  331. 

fear,  251. 

free  air,  129,  149. 

infection,  74,  84,  101,  106,  196,  218. 

infection  and  age,  123. 

modifying  symptoms,  295. 

"beneficent,"  68. 

book,  66. 

city,  63. 

country,  63. 

dwellings,  67. 

featherbed,  67. 

glass,  64. 

indoor,  66. 

kinds,  62. 

library,  66. 

paved  street,  64. 

poison,  73. 

pollen,  64,  128. 

problem,  328. 

spit,  65. 

sterilized  and  unsterilized,  68. 

theory,  132,  202. 

and  imagination,  248. 

and  storms,  162. 

and  sunlight,  27. 
Dust  Victims,  17,  63,  73. 

classification,  73. 
simple,  74. 
rheumatic,  75. 
dyspeptic,  75. 
nervous,  76. 
cardio-vascular,  76. 

educated,  196. 

symptoms,  183. 
Dwellings,  67. 
Dysmenorrhea,  121 
Dyspepsia,  55,  75,  151,  190. 

American,  175. 
Dyspeptic  Dust  Victims,  75. 
Dyspeptics,  old.  80. 
Dyspnea   (difficult  breathing),  277. 


INDEX. 


345 


Early  records,  54. 

Early  settlers,  46,  54. 

Ears,  buzzing,  105. 

East  Wind,  317. 

East  Wind  and  Mrs.  Browning,  317. 

"Easy  Marks,"  218,  222. 

Ecology,  45. 

Eliot,  George,  318. 

Emaciation,  191,  278. 

English  biographies,  120,  317. 

Englishmen,  three  visiting,  321. 

Environment,  172. 

alteration,  88. 

influence,  42,  305,  332. 

simple  and  complex,  157. 

and  heredity,  35,  120,  263. 

and  worry,  286. 
"Equable  temperature,"  school 

room,  26. 
Ethics,  medical,  108. 
Europe  vs.  Cathay,  334. 
European  weeds,  47. 
Euthanasia,  273. 

"Everybody  has  catarrh,"  00,  103. 
Evolution  and  discussions,  275. 
"Examinations  free,"  108. 

"thorough,"  136. 
"Exceedingly  careful,"  178. 
"Exciting  causes,"  113. 
Expectoration  or  spitting,  69. 
Experienced  chronics,  306. 

patients,  68,  307. 
Experimenting,  248. 

on  hens,  249. 
Experimental  evidence,  250. 

medicine,  249. 
Experiments  by  patients,  250. 

and  private  practice,  250. 
Explanations  of  ill  health,  11. 

a-b-c,  206,  228,  241. 

"biliousness,"  160. 

common,  16S. 

fashionable,  30. 

"overwork,"  25. 

"It's  dyspepsia,"  37,  38. 

"It's  grip."  19. 

"It's  the  liver,"  37,  168. 

"It's  malaria,"  19. 

"It's  the  noise,"  30. 

"It's  the  stomach,"  38. 

"It's  uric  acid,"  37. 

"It's  what  I  eat,"  19. 

or  diagnoses,  38. 

vs.  facts,  149. 
Exposure  and  colds,  114. 
Eyestrain,  317. 


Factor,  seasonal,  101. 
Facts  vs.  explanations,  140. 
Faddists,  158. 
Fads  vs.  cleaning  up,  23S. 
Faith  cures,  311,  332. 

curist,  288. 

and  mind  cures,  132. 
False  malaria,  200. 
Familial  diseases,  273. 
Family,  adapted,  110. 

histories,  117,  110,  121,  202. 

history,  good,  01. 
"Family  history  negative,"  118. 
Family  physician,  best,  200. 

and  specialist,  16. 
Farmer,  old  settler,  14. 

retired,  162. 

and  dust,  68. 
Farmers'  Bulletins,  206. 
Farming  and  weeds,  300. 
Fasting,  276. 
Fatigue,  278. 

Favorite  Prescriptions,  231. 
Fear  an  instinct,  251. 

and  uses.  2SS. 
Fears  and  Phobias,  251. 
Featherbed  dust,  67. 
Fees  and  honorarium,  41,  133,  214. 

254,  335. 
Fellow-students,  78. 
Fever  as  a  symptom,  246,  278. 
"Filled  up  on  city  dust,"  310. 
Filth  diseases,  206. 
Filth  on  streets  and  sidewalks,  117 
Flatulency.  101. 
Fleas  and  plague,  203. 
Flies,  200,  205.  300. 
Flushing,  101,  281. 
Food.  20,  158,  164. 
Foundlings,  122. 
Franklin,  Benj.,  140,  330. 

and  colds,  213. 
Frying  food,  21. 
Funny  advice,  226. 


Gall  Stones,  167. 

Gastritis,  154. 

General  run  of  cases,  12. 

statements  and  exceptions,  12. 
Germans,  175. 
German  books,  160,  256. 

sanatoria,  120,  140. 

specialist,  160. 
Germ  theory,  44. 
"Germs  are  everywhere,"  146. 


;ug 


DUSTY    AIR    AND    ILL    HEALTH. 


Germs  and  diseases,  259. 

and  dust,  27. 
Getting  the  feel  wet,  74. 
Ghettoee,  122,  34. 
Ginseng  disease,  ss. 
(J lass.  lCo. 

dust.  (i4. 
Goldenrod,  4P. 
Golden  Weddings,  125. 
Gonorrhea,  299. 
Good  air.  2.")C>. 

Influences,  220. 

family  history,  91. 

samaritan,  physician.  335. 
Going  to  church  or  not,  269. 
Gout  and  gouty,  75. 
Gray  hair  and  age,  2S3. 
Greens,  102. 
Crip.  292. 

as  an  explanation,  97. 
"Guaranteed"  nostrums,  225. 

Pure  Food  and  Drug  Act.  225. 
Guarantee  to  cure,  229. 
Guesswork.  22<>. 

Handkerchiefs,  70. 
Hay-fever,  65,  104,  12S. 

and  climate.  229. 

and  cures,  247. 
Habit-forming  drugs,  237. 
Headache.  184,  191. 
Healing  herbs,  262. 
Heart,  weak,  2S4. 

and  kidney  cases,  258. 

and  kidney  diseases,  220. 
Health  inspection,  61. 

in  city  and  country.  141. 

supervision,  255,  61,  155,  197,  199. 
"Healthy."  49. 

color.  283. 

the.  77. 
Hereditary  tendencies,  263. 
Heredity  vs.  environment, 

35.  120.  263. 
High  blood  pressure.  220,  25S,  279, 

and  age,  264. 
High  pressure,  264. 

club,  26S. 
High  school  and  air,  25,  204. 
High  standard  in  medical  edu- 
cation, 206. 
Hindus,  292. 
Hippocrates,  146,  210. 
Historians,  314. 
Histories  of  ill  health.  310. 
Honorarium,  41,  335. 


llousocleaning,  110,  194. 

colds.  110. 
House  parties,  155. 
Houses,  overheated.  25. 
Hospital  cases,  172. 

physicians,  252. 
Hunters  and  trappers,  50. 
Huxley,  T.  H..  826,  320. 
Hydrochloric  acid,  176,  265. 
Hyperacidity  of  the  stomach,  279. 
Hypochondria,  76. 
1  [ypodermics,  154. 
Hysteria,  76.  212. 

Idiosyncrasy,  73. 
"Idle  rich,"  305. 

Ill  Health,  explanations   (see  under 
Explanations). 

symptoms  (see  under  Symptoms). 

and  biography,  IS.  93.  302,  313. 

and  disease,  42.  49,  53,  287. 

and  Letters,  319. 
Ills  as  reactions,  234. 
"Imaginary"  diseases  and  ills, 

76,  174,  215,  244. 
Immigrants,  46. 

Immunes  and  Immunity,  209,  293. 
Impure  blood,  2S0. 

milk,  330. 
Influence  of  environment   (see  En- 
vironment ) . 
Influences,  mental,  272. 
Influenza,  291. 
"Incurable   disease"    and   long   life, 

25S,  327. 
Indians,  The,  45,  4S,  50,  54,  87,  147, 

194.  263,  2S1,  291. 
Indian  medicine  man,  59. 
Indiana  biographies,  314. 

climate,  45. 

State  Medical  Society,  59. 

topography,  45. 
Industrial  diseases,  56. 
Indoor  climate,  33,  74,  96,  128. 

dust,  66. 
Inheritance,  as  an  explanation,  35. 
Insane  Hospital  practice,  252. 

and  pneumonia,  296. 
Insomnia,  192,  279. 
Intercostal  neuralgia,  132. 
"Interesting  cases,"  41. 
Intestinal  mucus,  168. 
Intestines,  Membi'anous  Catarrh, 

76,  174. 
Irish,  175. 
Isolation,  86,  268. 


INDEX. 


347 


"It's  dyspepsia,"  37. 

"It's  grip,''  19. 

"It's  malaria,"  19. 

"It's  the  liver,"  160,  107,  168,  185. 

"It's  the  noise,"  30. 

"It's  the  stomach,"  160. 

"It's  what  I  eat,"  19,  159. 

Janitors,  270. 
Japanese  and  clothing,  24. 
Jews,  The,  34,  56,  122. 
Johnson,  Samuel,  268,  297. 
Joint  pains,  192. 

Kankakee  Swamps,  300. 

Keeping  a  daily  record,  271. 

Keeping  up  pressure,  262. 

"Kickers,"  221. 

Kidney  and  Heart  cases,  258. 

Kidney  and  Heart  diseases,  220. 

"Kill  the  pain,"  237. 

Kindred  minds,  268. 

Kinds  of  colds,  106. 

Knife  grinder's  rot,  261. 

"Knockers,"  271. 

"Knocking  out  rheumatism,"  133. 

Know  Thyself,  332. 

Know  your  city,  332. 

Laboratories,  60. 
Laboratory  doctor,  335. 

findings,  274. 
Lack  of  ambition,  192. 
La  Grippe,  291. 
Laissez  faire,  98. 
Laxatives,  166,  189. 
Lead  poisoning,  49. 
"Leave  everything  to  the  doc- 
tor," 112. 
Length  of  life,  328. 
Lent,  "Being  Done  Good,"  132,  183. 
Leprosy,  290. 
Lesions,  76. 
Letters,  George  Eliot,  318. 

and  references  to  ill  health,  319. 
Let  the  buyer  beware,  234. 
Let  us  pray,  2S7. 
Library  dust,  66. 
Libraries,  67,  314. 
Life  insurance,  260. 

story,  36,  263. 
Life  and  Letters,  Darwin,  302. 

Huxley,  326. 
Limitations,  Huxley,  13S,  326. 
Literary  men,  192,  314. 
"Lives"  of  the  dead,  302,  313. 


Living  in  isolation,  268. 

Local  conditions  and  changes,  45. 

Localized  pain,  131. 

Looking  for  the  worst,  90. 

Long  life  and  old  chronics,  91. 

Loss  in  weight,  278. 

Lot  and  land  poor,  221. 

Low  blood  pressure,  258. 

"Lowered  vitality,"  332. 

Lumbago,  72,  132. 

"Lung  trouble,"  122. 

Malaria,  49,  289. 
a  touch  of,  18,  290. 
as  an  explanation,  IS. 
concealed,  18. 
false,  290. 
and  quinine,  201. 
Man  above  forty  years,  56. 
Manifestations  of  colds,  116. 
Marble  statue,  story,  238. 
Measles,  291. 
Medical  biography,  314. 

schools  and  colleges,  59,  79, 

205,  210. 
inspection,  schools,  61,  87,  330. 
profession  and  Dickens,  324. 
science  and  the  uncured,  118. 
societies,  134. 
supervision,  255. 
Medicine,  an  evolution,  41. 
art  or  science,  177,  248,  320. 
Darwin's  influence,  320. 
men,  11,  59. 

men  and  newspapers,  223. 
Medicines  "guaranteed  to  cure,"  15. 
the  right  ones,  228. 
and  mystery,  231. 
Meeting  places,  51. 
and  doctors,  149. 
Membranous  catarrh  intes- 
tines, 76,  174. 
Mental  influences.  272. 
life,  306. 
reaction,  253. 
stimulation,  192. 
symptoms,  192. 
Mesology,  45. 

Microbes,  disease-producing,  25. 
Milk  problem,  330. 
sickness,  289. 
and  bacteria,  147. 
Milton,  314. 
Minds,  kindred,  268. 
Mineral  springs,  132,  160. 
Missing  factor,  102. 


348 


DUSTY    AIR    AND    ILL    HEALTH. 


Missionaries,  54. 
Missionary  spirit,  7S. 
Misunderstood  dyspeptics,  152. 

patients.  174. 
Modern  flat  dweller,  20. 
Moliere,  57. 

Moods  and  writing,  316. 
Moribund,  the,  78. 
Mortality  from  typhoid  fever.  295. 

statistics.  31. 
Morton.  O.  P.,  315. 
Mosquitoes,  is.  40.  53,  2S9. 
"Mountain  disease."  244. 
Mountaineers,  34.  50.  91,  200,  334. 
Moving  about,  33. 

advising,  271. 
Mucus  formation.  76,  104.  195,  27!>. 

and  dust,  00. 
Muscular  pains,  193. 
Mysterious  attacks,  154. 

cases,  174. 

Names  concealing  ignorance,  113. 
Naming  diseases,  15S. 
National  Department  of  Health, 
27,  60. 

diseases  (see  Triad). 
Nationalities,  46. 
Natives  (Indians),  45. 

(whites).  46. 
Natural  vs.  artificial  food.  20. 
Nature,  personifying,  2S1. 
Negroes  and  weeding  out.  271. 
Neglected  factor,  the,  102. 
Neglecting  symptoms.  272. 
Nervous  prostration,  212. 

dust  victims,  76. 
Nervousness,  193. 
Newspaper,  12. 

clipping,  297. 

medicine,  30,  220. 

writing,  221,  240. 

and  advertisements,  234,  235. 

and  medicine  men,  223. 
Neuralgia,  2S0. 
Neurasthenia,  39,  76,  212. 

and  Dr.  Beard,  213. 
Neuratheniacs  and  the  doctors.  214. 
Neurastheniacs,  214,  251. 
Newborn,  123. 
New-fangled  diseases,  14. 
New  remedies  and  seasonal  in- 
fluences, 312. 
Night  air,  IS. 

thoughts,  272. 
Nine-tenths  and  one-tenth,  12. 


Nostrum  evil,  224. 
Nostrums,  132.  224,  288. 

habit-forming,  224. 
"Nothing  the  matter,"  215. 
"Nothing  organic  the  matter,"  200. 
Novelists,  314. 
Novel  reader,  S4. 
Numbness,  100. 
Nurses,  trained,  211. 

Objective  symptoms,  250. 
Occupation  and  ill  health,  49. 

and  disease.  40. 
Occupational  diseases,  56. 
Occupations,  33,  49,  51,  124,  261. 

and  meeting  places,  51. 
Odors  and  Arabs,  92. 
Old  age,  125. 

and  arteries,  256,  262. 

and  ill  health,  256. 
"Old  Age  Deferred,"  255. 
Old  chronics,  12,  SO,  82,  256. 

and  long  life,  91. 
Open  air  schools,  28. 

and  man.  20. 
Open  door  season,  133,  163,  232,  330. 
Opium,  224,  237. 
Oppression  of  the  chest,  189. 
Outdoor  life,  131. 
Outgrowing  ills,  201. 

primitive  ideas,  334. 
Overcrowding,  32,  85,  94,  109, 

237,  202. 
Overeating,  155. 
Overgrown  villages,  143. 
Overheated  houses  and  rooms, 

25,  116. 
Overwork,  28,  US,  212,  217, 

278,  305,  322. 
"Overwork"  as  an  explana- 
tion, 25,  217. 

Pain,  2S0. 

"killer,"  136,  193. 

psychical,  2S1. 

vs.  complexion,  2S2. 

and  fear,  251. 
Pains  and  aches,  184,  251. 

as  warnings,  42. 
Palpitation,  194. 
Panama  Canal,  331. 

and  sanitation,  254. 
Papaws,  21,  73. 
Paralysis,  76,  258. 
Parasites,  48. 
Paratyphoid  fever,  295. 


INDEX. 


349 


Passenger  conductors,  307. 

trains  and  spitters,  308. 
Patent  medicine,  42,  104,  175,  219, 
221,  224,  228,  231. 

Advertisements,  32,  101,  150,  150, 
166,  170,  220,  288. 

"harmless,"  224. 

"jokers,"  230. 

man,  288. 

prescriptions,  230. 

testimonials,  232. 

and  cleaning  up,  225,  237. 

and  closed  door  season,  170,  225. 

and  patients,  228. 

and  physician,  237. 
Pathological  museums,  87. 
"Pathology  of  the  living,"  42. 
Patients,  average,  305. 

advising  to  move,  271. 

classifying,  76,  303. 

experienced,  307. 

philosophical,  267. 

as  bugbears,  243. 

as  fellow-students,  78. 

and  experiences,  177. 

and  experiments,  250. 

and  patent  medicines,  228; 
Peculiar  cases,  1.64. 
People,  classifying,  77. 

not  worth  while,  232. 

wants  and  needs,  11. 
"Perfect  health,"  100. 
Perils,  44,  328. 

and  a  remedy,  328. 
Personal  mention,  79,  115. 
Pests  and  parasites,  47,  130. 
Philippines,  254. 
Philosophical,  the,  267,  274. 
Phobias,  251. 

Physical  vs.  mental  life,  306. 
Physician  (see  also  Doctor). 

best  family,  209. 

good  Samaritan,  335. 

old  time  definition,  246. 

placing  the  blame,  335. 

promising  to  cure,  223. 

robust,  207. 

teaching  sanitation,  336. 

vs.  surgeon,  324. 

and  acute  diseases,  223. 

and  antagonism,  214. 

and  country  life,  20S. 

and  esprit  de  corps,  248. 
and  ill  health,  20S. 
and  patent  medicine,  237. 
and  simple  remedies,  246. 


Pie,  19,  159. 
Pill  -peddlers,  220. 
Pimples,  281. 
Placing  the  blame,  335. 
Plague,  292. 
Plants  and  man,  85. 
Plato,  207,  261. 
Pleurisy,  132. 
Pleurodynia,  132. 
Pneumonia,  296. 
an  index,  29(5. 
and  the  insane,  296. 
at  Goldfield,  297. 
Poets,  city,  314. 
country,  314. 
"Poisoned  secretions,"  104. 
Political  meetings,  73,  159. 
Politics  and  politicians,  239,  241. 
Pollen  dust,  64,  128. 
Pollenosis,  72. 
Polo,  95. 

Poolroom  air,  126. 
Poor  people,  32,  125,  133,  137,  226, 

261,  306. 
Postmortem  pathology,  42. 
Prediction,  the  test  of  science,  260. 
Predicting,  258. 
Premature  baldness,  283. 
Prescott,  W.  H.,  317. 

Prescribing  for  oneself,  246. 
for  the  community,  219. 

Prevalent  ill  health,  42. 

Preventable  accidents  and  dis- 
eases, 335. 

Preventing  ill  health,  228. 

Primitive  man  and  open  air,  20. 

Professions   (see  Occupations  and 
Trades). 

Prognosis,  199. 

Promising  to  cure,  38. 

"Protean  disease,"  218. 

Providence  and  acute  diseases,  261. 

Prudent  people,  44,  258. 

Pseudo  specialist,  135. 

Psychasthenia,  112. 

Psychotherapy,  334. 

Ptomaines,  53. 

Publishing  paj)ers,  134. 

Pullman  coaches,  110. 

Pump  Towns  and  "Abe  Martin,"  23. 

Pure  Food  and  Drug  Act,  225,  233. 

Pure  water  conscience,  331. 

Pure  air  and  typhoid  fever,  295. 

Puzzling  cases,  217. 

Quinine,  201,  284,  289. 


350 


DUSTY    AIR    AND    ILL   HEALTH. 


Race  suicide,  208.  328.  330. 

and  false  malaria.  290. 
Ragweed,  49,  65,  128. 
Railroaders,  200.  307. 
Railroad  cases.  209. 
Railway  coaches,  110. 

colds.  110. 

stations,  222. 
Railways  and  weeds,  293. 
Rare  vs.  common  diseases.  15. 
Rats  and  plague.  293. 
Reading  notice.  229. 
Record,  daily.  150,  180,  201. 
Real  specialists,  135. 
Relief  \  s.  cure,  233. 
Remedy.  The.  329. 
Remedies  superficial,  332. 
Reporting  cases.  210. 
Reprints,  81. 
Retired  farmers.  102. 
Rheumatic  cases.  131,  114. 

dust  victims,  75. 

sore  throat,  145. 
Rheumatism,  137. 

"knocking  out."  133. 
Right,  the.  "to  doctor."  336. 
Robust  countryman.  122. 

doctor.  29,  207.  236. 

teachers.  29. 

the,  and  sudden  death,  258. 
Rose  cold.  65. 
Routine  attention.  220. 
Ruling  out,  163,  171. 
Rural  ancestors.  34,  122. 

life,  142. 
Rush  of  thoughts,  306. 
Rusts  and  blights.  47. 

Saleeby,  Dr.,  329. 
Sallowness,  2s2. 
Sanitarian,  238,  336. 
Sanitation,  143. 

Dickens  influence  on,  325. 

and  Panama.  254. 
Sanatoria.  132. 

German.  129. 
Sassafras,  102. 
Scar  tissue,  S7. 
Scarlet  fever,  291. 
Schools,  52,  124,  204,  291. 
School  children,  28,  77,  84,  330. 

colds.  111. 

life.  123. 

medical  inspection,  61,  87,  330. 

open  air,  28. 


School  room  temperature,  26. 

teacher,  robust,  29. 
Schools  and  cleanliness,  335. 

and  weeding  out.  203. 
Scientists  and  ill  health.  320. 
Scotch,   119. 
Seasonal  factor,  101. 

influence,  232,  242. 

influence  and  new  remedies,  312. 
Seclusion,  advising,  269. 
Secondhand  notes,  196. 
Seelenleben,  273. 

Selected  rases.  310. 
Servant   girls.  211. 
Settlers,  early.  4(i 
Short  and  simple  annals,  217. 
Shopping,  130,  1V7. 

as  a  recreal  ion.  243. 
Siderosis,  72. 
Sidewalk  spitting.  71. 
Silicosis.  72. 
Simple  dust  victims.  74. 

Case  Reports  of  S4,  90,  93. 

life.  the.  50.  54,  194,  334. 

life  and  worry.  286. 

the,  vs.  the  complex,  13. 
Skin,  dryness,  190. 

symptoms,  2S1. 
Sleeplessness,  192. 
Slums.  S7. 

Slum  disease  and  cleanliness,  325. 
Smallpox.  48,  290. 
Smith.  Adam,  119,  330. 
Smog.  06. 

cloud,  173. 
Smoke.  66. 

evil,  331 

injuriousness,  66. 
"Smoke  disease,"  244. 
Smoke  and  smog,  66. 
Smoking  and  mosquitoes,  18. 
Social  aspirations,  269. 
Socialism.  240. 

Socialism  vs.  individualism,  240. 
Soil  exhaustion,  142. 
Specialists.  CO.  134,  160. 

German,  160. 

and  family  physician,  16. 
Specific  diseases,  289. 

diseases  and  causes,  53. 
Specimens  (plants  and  dis- 
eases). 301. 
Spencer,  Herbert,  273,  327. 
Spit  dust,  65. 
"Spit  dust  rheumatism,"  145. 


INDEX. 


351 


Spitter's  country,  323. 

town,  80,  143. 
Spitting,  28. 

black,  70,  194. 

habit,  69. 

habit  and  Dickens,  321. 

or  expectoration,  69. 
Spittle  pulverized,  326. 
Stages  of  civilization,  62. 
Standards,  high,  177. 
Standpoints,  43. 
State  Fair  colds,  96. 
Statistics,  mortality,  31. 
Staub-freie  Luft,  149. 
Stegomyia   (mosquito),  290. 
Sterilized  and  unsterilized  dust,  68. 
Stevenson,  Robert  Louis,  118. 
Stock  of  health,  243. 
Stomach,  hyperacidity,  279. 

trouble,  122,  154. 
Store  keeper,  51. 
Stores,  unventilated,  153. 
Storms,  201. 

and  dust,  162. 
Street  cleaning  and  women,  336. 
Street  lights,  219. 

Streets,  dirty  and  dusty,  64, 145,  238. 
Strenuous  life,  264. 
Students  of  biography,  311. 
Studying  diseases  and  ill  health,  57. 
Study  your  own  cases,  248. 
Subjective  symptoms,  259. 
Subconscious  cerebration,  192. 
Suburbs,  143. 
Sudden  recoveries,  140. 
Stump  speeches,  indoor,  239. 
Suggestion,  193. 
Sunday,  a  day  of  rest,  126. 
Sunlight,  68. 

and  dust,  27. 
Surgeon,  60. 

and  physician  (see  physician). 
Surgical  cleanliness,  174. 
Survival  of  the  best,  119. 

of  the  fittest,  91,  94,  119,  122,  124, 
264,  275. 
Susceptibility,  27,  50. 

unusual,  202. 
Symptoms-complexes,  212. 

names  (Huxley),  327. 

prescribers,  94,  158,  189,  220. 
Symptoms,  172,  181,  1S3,  212. 

common,  56. 

detailing,  318. 

discussing,  185. 

discussion,  274. 


Symptoms,  "driving  out,"  275. 

high  blood  pressure,  260. 

mental,  192. 

modifiable,  283. 

neglecting,  11,  272. 

objective,  274. 

secondary,  283. 

skin,  281. 

subjective,  274. 

subjective  and  objective,  259. 

vague,  184. 

as  reactions,  245. 

as  warnings,  42,  184,  192,  275.  276, 
287,  324. 

in  typhoid  fever,  295. 

of  ill  health,  185,  275. 

of  disease,  275. 

vs.  affections,  286. 

vs.  diseases,  287. 

and  dangers,  245. 
Syndromes,  212. 
Syphilis,  299. 

Table,  Evolution  of  Dust,  62. 

Evolution  of  Physician,  58. 
Tabooed  topics,  273. 
Tanner,  Dr.,  and  fasting,  276. 
Tax  Payer's  cold,  98. 
Teachers,  robust,  29. 
Teachers'  Institutes,  109. 
Teaching  young  and  old,  335. 
Teeth,  artificial,  2S3. 
Temnerate  zone,  54. 
Tenements,  300. 
Terminal  disease,  35. 

infection,  25S. 
Testimonials,  232. 
Theaters,  52,  243,  282. 
Theory,  working,  40. 

of  dust  infection,  133. 
Thoughts,  "rush  of,"  306. 

train  of,  272. 

writing  them  down,  272. 
Threatened  with,  296. 

pneumonia,  38. 

consumption,  38. 
Time  lost  and  ill  health,  125. 
Tinnitus  (buzzing  of  ears),  2S4. 19o 
Tobacco  chewing,  65,  69. 

smoking,  18. 

spittle,  65. 
Tongue,  coated,  1S6. 
Tonics,  186,  249,  276. 

for  laying  hens,  249. 
Tonsillitis,  145. 
Topography,  Indiana,  45. 


352 


DUSTY    AIR    AND   ILL    HEALTH. 


Touch  of  malaria,  a.  18.  1GS,  290. 
Towns,  unhealthy,  31. 
Trades  and  professions,  204. 

i  See  also  Occupations.) 
Tradition  and  physician,  335. 
Trailing  dresses.  (">.*>,  155. 
Tramontana    (East  Wind),  31S. 
Traveling  facilities,  129. 
Trembles,  2S9. 
Triad   of  National   Diseases.   17.  7<i. 

105.  KIT.  212,  21!>.  320. 
Trolley  Cars,  70.  110. 
Truth,  telling.  199,  247. 
Tuberculosis,  171,  293. 

Case  Report,  294. 

as  a  protest.  2'.M. 

and  weeding  out.  2!)4. 
Typhoid  fever.  295. 

as  an  index,  296. 

and  backward  communities,  295. 

and  bad  water.  229. 
Typical  cases,  172. 

Underwear.  178. 
Unhealthy  towns,  31. 

trades.  149. 
Unions,  137,  219,  262. 
Urban  aneestors.  34.  122. 

life.  142. 
Uric  acid,  192. 

acid  in  the  blood,  39. 

Vacations  and  typhoid  fever.  2*.!5. 

Vaccination.  290,  295. 

"Vacuum  cleaner  colds,  112. 

Varied  diet,  158. 

Varying  manifestations  of  colds,  116. 

Ventilation.  25,  52,  204. 

Vertigo,  195. 

Violent  methods.  141. 

Visitations,  287. 

Vitality,  lowered,  332. 

Vomiting,  384. 


Walking.  323. 
Wants  and  needs.  11,  77. 
War  and  weeding  out,  94. 
Wash  and  be  clean,  23. 
Water,  22,  27,  164. 

clean.  23S. 

muddy.  22,  218. 

and  salubrity.  238. 

and  typhoid  fever,  27,  295. 
Ward.  Lester  F.,  333. 
Warnings   (see  Symptoms). 
Weak  heart.  2S4. 
Weeded-out  families,  94. 
Weeding  out.  50,  142.  275,  2!)4. 

on  account  of  ill  health  and  dis- 
ease. 199. 

and  schools,  203. 
Weeds  and  diseases,  54,  300. 
Weight,  loss  of,  278. 
Whit  tier,  J.  G.;  316. 
Windstorms,  67,  101,  201. 
Wind,  East,  317. 
Winter  cough.  100. 
Women  and  Case  Reports,  303. 

and  cleaning  up,  226. 

and  stx-eet  cleaning,  336. 

and  voting,  240. 
"Wonderful  climate,"  130. 
"Wonderful  new  methods."  223. 
Woodruff,  Dr.,  292. 
Wordsworth,  Wm.,  314. 
Working  theory,  40. 

under  high  pressure.  2<i2. 
Worry.  216,  251.  285. 
Writing  to  the  newspapers,  240. 
Writing  and  moods,  316. 

in  bed,  272. 
"Wrong  medicine,"  101. 

X-colds,  113. 

Yellow  fever,  290. 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
provided  by  the  rules  of  the  Library  or  by  special  arrange- 
ment with  the  Librarian  in  charge. 


C28(l14l)M100 


RA575  H41 

Hessler 


